Providers

D.  Provider Information – Part 2 of the Application

Revised: November 7, 2007

Clarifying Information

The WCAP generates the DSHS 14-417, which is the two-part WCCC application. Part 2 of the 14-417 is the Provider Information Form which is an information-gathering tool for the department and the consumer.

Licensed providers: Part 2 can be completed:

1. By the provider and returned to the local office; or

2. With you over the phone.

In-home/relative providers:

1. The consumer and provider must complete Part 2 in writing; they cannot complete the form over the phone.

2. When signing the form, the consumer and provider state they understand the child care arrangement, rules and their responsibilities.

3. If the child and provider live in the same home, we consider it to be the child's home.

Worker Responsibilities

Providers not meeting WAC 170-290-0125 are not eligible providers. The consumer remains eligible for WCCC and can look for another provider.

You should review the part 2 information for accuracy every 6 months or at least every year. If there are significant changes, the provider and consumer should complete a new form. For the in-home / relative provider, the provider and consumer must submit a new form if there is a change in the location of care or if the consumer moves into the same home as the provider.

Licensed Providers:

1. When the provider completes and returns Part 2, review the form to be sure you have enough information to authorize child care. Part 2 must include the provider's usual rate for the child according to their age and type of care. For example: If Part 2 includes only full-day rates and care is for half-days, contact the provider for their half-day rate. Do not assume the provider's half-day rate equals one half of their full-day rate.

2. When you collect Part 2 information over the phone, ask for the provider's usual rate information for:

   • The child's age and type of care

   • Field trip fee

   • Registration fee

   • Any request for special needs rates for the child

   Be sure to document the information received.

In-Home/Relative Providers:

1. Review Part 2 for completeness and clarity. Accept the form only if the consumer and provider completed all sections, including the provider's usual rate for the child according to their age.

   • If information is missing return the form to the consumer

   • If information is unclear you can contact the provider for clarity and document the information OR return the form to the consumer

2. This form gathers information used to decide what SSPS service code you use to authorize care. Incomplete or unclear information could result in the wrong SSPS service code being used. The SSPS service codes determine:

   • Whether the State withholds taxes

   • What type of tax form the State sends the provider (1099 or W-2)

   • Which Union benefits some in-home/relative providers receive

Authorizing care under an incorrect code creates tax issues for the provider and affects Union benefits. Carefully review Sections 2 and 5 on Part 2. WCAP asks you questions during the authorization process. The correct answer to these questions directs you to using the correct code. The chart below illustrates how the different codes can affect the provider.

3. If the provider completed Section 6 be sure to send the necessary forms to the consumer.

4. See clarifying information under WAC 170-290-0130 and 170-290-0135 for more information regarding approving in-home/relative providers.

You are responsible to authorize the correct code based on the information the consumer and provider give you. Based on the code you authorize, the following applies: