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Fill a Valid Georgia 57 Template

The Georgia 57 form is a crucial document used for child care referral and application for supplemental supervision. It helps ensure that foster children receive the appropriate care and support they need while living in foster homes. This form collects essential information about the child, the foster care placement, and the child care provider, facilitating effective communication between case managers and families.

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Article Structure

Common mistakes

Incomplete Information: Failing to fill in all required fields can lead to delays. Ensure that all sections, especially in part A and C, are fully completed.
Incorrect Dates: Providing incorrect or inconsistent dates can cause confusion. Double-check the dates for the child's birth and the start date for CAPS.
Missing Signatures: Not obtaining the necessary signatures can result in the application being rejected. Ensure that both the foster care case manager and the CAPS case manager sign the form.
Failure to Report Changes: Not reporting changes in the child's placement or care arrangements within the required timeframe can affect eligibility. Report any changes within 5 working days.
Incorrect Selection of Care Type: Misclassifying the type of childcare provider can lead to issues. Be clear about whether the provider is a relative or non-relative and ensure the correct boxes are checked.
Omitting Financial Information: Not providing accurate cost information can hinder the eligibility determination process. Include the cost of care if it exceeds the maximum allowed.

Essential Points on This Form

What is the purpose of the Georgia 57 form?

The Georgia 57 form is used to apply for supplemental supervision for children in foster care. It helps ensure that children receive the necessary child care services while in a foster placement. The form gathers important information about the child, their foster care situation, and the child care provider. By completing this form, foster parents or case managers can facilitate access to essential resources and support for the child’s well-being.

Who is responsible for filling out the Georgia 57 form?

The form must be completed by the Social Services Case Manager (SSCM) or the foster parent. It requires details about the child, including their personal information, the foster care placement, and the child care provider. The SSCM plays a crucial role in ensuring that all sections of the form are accurately filled out and submitted to the appropriate department for processing.

What information is required on the Georgia 57 form?

The form collects various details, including the child’s name, date of birth, and social security number. It also asks for information about the foster care placement, such as the foster parent’s name and contact details. Additionally, it requires specifics about the child care provider, including their name, address, and phone number. It’s essential to provide accurate and complete information to avoid delays in processing the application.

What happens after the Georgia 57 form is submitted?

Once the form is submitted, a CAPS case manager will review the application to determine eligibility for child care assistance. They will assess factors such as family unit size and the cost of care. The application can be approved or denied based on these criteria. The case manager will also provide official certification periods for approved applications, ensuring that the foster child receives the necessary support during their time in care.

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Georgia 57 Sample

Date Received by CAPS

Georgia Department of Human Resources

CHILD CARE REFERRAL & APPLICATION FOR SUPPLEMENTAL SUPERVISION

___________ County Department of Family and Children Services

A. FOSTER CHILD INFORMATION (To be completed by SSCM)

First Name MI Last Name Sex

Date	Social Security	Child	Child
of	Number	in	in
Birth		School	Pre-K

Child

Head

Start

Child has a disability

Ethnicity (check one):	Hispanic	Not Hispanic
Race (check one):	White	Black/African American	Asian
	American Indian or Alaskan Native		Native Hawaiian or other Pacific Islander

B. FOSTER CARE PLACEMENT INFORMATION (To be completed by SSCM)

Foster Parent's Name

Address

Home Phone

		Work Phone #

If an informal childcare provider has been chosen, check all that apply:
Relative of Child	Care provided in child's home	CRC completed
Non-Relative	Care provided in provider's home	CPS screening completed
		Approved by Foster Care

All changes in the child's placement and child care arrangements MUST be reported to the child care case manager within 5 working days.

____________________________________	________________	_______________
Signature of Foster Care Case Manager	Date	Case Load ID #

C. CHILD CARE PROVIDER INFORMATION (To be completed by the SSCM or Foster Parent)

Reason Care is Needed:

Days and Hours Care is Needed:

Date to begin CAPS: _____

Name, Address and Phone # of Childcare Provider:

Phone # :

D. ELIGIBILITY DETERMINATION (To be completed by the CAPS case manager)

1.	Family Unit Size	____		4.	Rate Within DFCS Maximum?		Yes	No
2.	UAS Code (check one):				Cost of care if not within maximum $_________
		555 (Pre-K)	557
3.	Provider is:			5.	Application Disposition:	Approved		Denied
	Licensed, Commissioned, or Exempt
	Registered			6.	Official Certification Period:
	Informal- Relative of Child				___________________ to __________________
	Informal- Non-Relative

Comments:

________________________________	_____________________	_____________________
Signature of CAPS Case Manager	Date	CAPS Case Load ID #

Form 57 (3/2004)

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Key takeaways

When filling out and using the Georgia 57 form, it is essential to keep the following key takeaways in mind:

Accurate Information is Crucial: Ensure that all sections, particularly the foster child and placement information, are completed accurately. This includes the child’s full name, date of birth, and social security number.
Timeliness Matters: Report any changes in the child’s placement or childcare arrangements to the case manager within 5 working days. Delays can affect the child's care and benefits.
Eligibility Determination: The CAPS case manager will assess the application based on family size, UAS code, and whether the childcare costs fall within the DFCS maximum rate.
Provider Information: Clearly list the name, address, and phone number of the childcare provider. This information is vital for processing the application.
Signature Requirement: Both the foster care case manager and the CAPS case manager must sign the form. Their signatures validate the information and the application process.
Understand the Application Disposition: Be aware of the possible outcomes of the application—approved or denied. Knowing this can help you prepare for next steps.

By adhering to these guidelines, you can ensure a smoother application process for the Georgia 57 form and better support for the child in your care.

Document Characteristics

Fact Name	Fact Description
Purpose	The Georgia 57 form is used for child care referral and application for supplemental supervision in foster care settings.
Governing Law	This form is governed by the Georgia Department of Human Services regulations regarding foster care and child welfare.
Completion Responsibility	The form must be completed by the Social Services Case Manager (SSCM) and the foster parent.
Foster Child Information	Section A requires detailed information about the foster child, including their name, date of birth, and disability status.
Foster Care Placement	Section B collects information about the foster care placement, including the foster parent's contact details and childcare arrangements.
Eligibility Determination	Section D assesses eligibility based on family unit size, care costs, and provider licensing status.
Reporting Changes	Any changes in the child's placement or childcare arrangements must be reported to the case manager within five working days.
Signature Requirement	Both the foster care case manager and the CAPS case manager must sign the form to validate the application.