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SAMHSA CCSP Applications

OPM Form 1644

SAMHSA CCSP Monthly Invoice

 

  

 

U.S. Department of Health and Human Services (HHS)Substance Abuse and Mental Health Services Administration (SAMHSA)CCSP supplemental instructions

  

 

In 2001, Congress passed legislation that allowed agencies to continue to provide subsidies for child care with appropriated funds.

 

The SAMHSA has a Child Care Subsidy Program for all SAMHSA civilian employees nationwide. Under the authority of Public law 107-67, this program is available through September 30, 2013. (The program will be extended annually - barring any budget complications.)

 

As a SAMHSA civilian employee, you are eligible to apply for assistance at any time during the program period if you meet the requirements.  

 

It is highly recommended that you print the following instructions for future reference.

 

  1. Eligibility
  • Your adjusted gross family income is $75,000 or less (IRS form 1040, Line 37)
  • Your child is age 13 or under (or 18 and under if physically or mentally unable to care for him/herself).
  • Your child is enrolled or has been approved for enrollment in a licensed child care center or under the care of a licensed child care provider.
  1. Definition of a Child

 

As provided in the regulations that implement Public Law 107-67, for the purposes of this program, a child is considered to be:

 

  • A biological child who lives with the Federal employee;
  • An adopted child;
  • A stepchild;
  • A foster child;
  • A child for whom a judicial determination of support has been obtained; or
  • A child to whose support the Federal employee who is a parent or legal guardian makes regular and substantial contributions.
  1. Application Process

The following information and forms must be submitted when applying for the subsidy program:

  • Application Form - HHS-698
  • OPM Form 1644, Child Care Provider Form - Please note: Your provider does not need to fill out section IV Provider’s Financial Institution.
  • SF-50 must be submitted
  • Pay statements for the two most recent pay periods for each parent or guardian
  • Most recent signed[1]IRS Tax filing forms for each parent or guardian
  • W-2’s for each parent or guardian
  • Copy of child care provider’s license or letter of compliance with state or local child care agency
  • Birth Certificate for each child
  • IRS W-9 to Verify Tax ID for Child Care Provider
  • Rate Sheet from Child Care Provider

 

Application forms may be obtained by requesting them from Rebecca.donnelly@psc.hhs.gov until a new webpage has been developed.

 

  1. Submission of Application

 

            Please send your completed application to:

 

            Rebecca M. Donnelly, PSC Child Care Coordinatorby:

 

                  - Fax – 1-240-465-0217

                  - emailRebecca.donnelly@psc.hhs.gov

 

                 

  1. Subsidy Allocations

 

The child care subsidy for all eligible employees will be a weekly amount of $75.00 per child per eligible household (or, if the amount paid for child care is less than $75.00 weekly per child, the lesser amount will be covered.)

 

The child care subsidy will be reduced by the amount the participant receives in State, county or local child care subsidies.

 

  1. Subsidy Approval

 

All new applications and annual enrollment re-certifications must be reviewed by the SAMHSAPSC Child Care Coordinator, Rebecca M. Donnellyfor processing and subsidy approval. 

 

  1. Instructions for submitting subsidy invoices

Once your application is approved, you will be able to receive the subsidy from the date that you applied. Please follow this link:www.1stfinancialassociates.comto obtain specific information for submitting child care invoices.

  • First Financial Associates, Inc.(FFA) is the company who processes payments.  They have seven days from the date they receive your invoices to send the checks to your provider. 
  • Please email your invoices to:

First Financial Associates, Inc.

pscccsp@1stfinancialassociates.com

  • Stacey Royal is the point of contact for First Financial Associates, Inc.
  • Download the invoice for the OPDIV you are employed by. At the end of each month after services have been rendered, your provider will fill out the form.
  • Both you and your provider sign the form and send it to FFA. They will process the invoice and send the check directly to your provider. Payments are made monthly and it’s important to get them to FFA as soon as possible.
  • The amounts claimed need to be in weekly amounts, not monthly amounts.
  • Each month’s child care ends on the last Friday of the month you are claiming.
  • Please make sure you use the correct OPDIVform as it could hold up payments.
  • The invoice needs to be emailed to FFA.
  • Invoices that are not received within 10 business days of the deadline must be approved by the PSC Child Care Coordinator.

 

  1. Annual Recertification

Continued participation in the Employee Child Care Subsidy Program requires an annual recertification by April 30th each year.  The following information must be submitted to the PSC Child Care Coordinator.  It will then be reviewed, approved and forwarded to First Financial Associates, Inc.:

  • SF-50 must be submitted
  • Pay statements for the two most recent pay periods for each parent or guardian
  • Most recent signed[2]IRS Tax filing forms for each parent or guardian
  • W-2’s for each parent or guardian
  • Application Form - HHS-698
  • OPM -1644, Child Care Provider Form - Please note: Your provider does not need to fill out section IV Provider’s Financial Institution.
  • Copy of child care provider’s license or letter of compliance with state or local child care agency
  • Birth Certificate for each child
  • IRS W-9 to Verify Tax ID of Child Care Provider
  • Rate Sheet from Child Care Provider

 

  1. Changes in Enrollment

 

When you sign the HHS-698, you agree to inform the PSC Child Care Coordinator and First Financial Associates, Inc. of any changes in your information listed on the applications. 

 

OPM-1644, Child Provider Form – Please note:  Your provider does not need to fill out section IV Provider’s Financial Institution.

 

Please contact us if your provider has moved and provide the PSC Child Care Coordinator with a copy of the provider’s new license.

 

IRS W-9 to Verify Tax ID of Child Care Provider

 

Rate Sheet from Child Care Provider

 

  1. Changing Providers

 

            When you change providers, please submit the following to the PSC Child Care

 Coordinator:

 

  • a new OPM 1644 before you start care
  • a new HHS-698 – Application Form
  • copy of the new provider’s license
  • IRS W-9 to Verity Tax ID of Child Care Provider
  • Rate Sheet from Child Care Provider

 

  1. Summer Camp

 

The subsidy may be used for summer camp as long as the camp falls into the following categories:

 

  • a licensed facility
  • a letter of compliance
  • a certificate to operate as a summer camp
  • IRS W-9 to Verify Tax ID of Child Care Provider
  • Rate Sheet from Child Care Provider

 

For enrollmentguidance and further information on the SAMHSA Child Care Subsidy Program, please contact:

 

            Rebecca M. Donnelly, PSC Child Care Coordinator

            Rebecca.Donnelly@psc.hhs.gov

            301-492-4080(office)1-240-465-0217(fax)

 

 

Manually signed or proof of an electronic signature if e-filed.

In 2001, Congress passed legislation that allowed agencies to continue to provide subsidies for child care with appropriated funds.

 

The SAMHSA has a Child Care Subsidy Program for all SAMHSA civilian employees nationwide. Under the authority of Public law 107-67, this program is available through September 30, 2013. (The program will be extended annually - barring any budget complications.)

 

As a SAMHSA civilian employee, you are eligible to apply for assistance at any time during the program period if you meet the requirements.  

 

It is highly recommended that you print the following instructions for future reference.

 

  1. Eligibility
  • Your adjusted gross family income is $75,000 or less (IRS form 1040, Line 37)
  • Your child is age 13 or under (or 18 and under if physically or mentally unable to care for him/herself).
  • Your child is enrolled or has been approved for enrollment in a licensed child care center or under the care of a licensed child care provider.
  1. Definition of a Child

 

As provided in the regulations that implement Public Law 107-67, for the purposes of this program, a child is considered to be:

 

  • A biological child who lives with the Federal employee;
  • An adopted child;
  • A stepchild;
  • A foster child;
  • A child for whom a judicial determination of support has been obtained; or
  • A child to whose support the Federal employee who is a parent or legal guardian makes regular and substantial contributions.
  1. Application Process

The following information and forms must be submitted when applying for the subsidy program:

  • Application Form - HHS-698
  • OPM Form 1644, Child Care Provider Form - Please note: Your provider does not need to fill out section IV Provider’s Financial Institution.
  • SF-50 must be submitted
  • Pay statements for the two most recent pay periods for each parent or guardian
  • Most recent signed[1]IRS Tax filing forms for each parent or guardian
  • W-2’s for each parent or guardian
  • Copy of child care provider’s license or letter of compliance with state or local child care agency
  • Birth Certificate for each child
  • IRS W-9 to Verify Tax ID for Child Care Provider
  • Rate Sheet from Child Care Provider

 

Application forms may be obtained by requesting them from Rebecca.donnelly@psc.hhs.gov until a new webpage has been developed.

 

  1. Submission of Application

 

            Please send your completed application to:

 

            Rebecca M. Donnelly, PSC Child Care Coordinatorby:

 

                  - Fax – 1-240-465-0217

                  - emailRebecca.donnelly@psc.hhs.gov

 

                 

  1. Subsidy Allocations

 

The child care subsidy for all eligible employees will be a weekly amount of $75.00 per child per eligible household (or, if the amount paid for child care is less than $75.00 weekly per child, the lesser amount will be covered.)

 

The child care subsidy will be reduced by the amount the participant receives in State, county or local child care subsidies.

 

  1. Subsidy Approval

 

All new applications and annual enrollment re-certifications must be reviewed by the SAMHSAPSC Child Care Coordinator, Rebecca M. Donnellyfor processing and subsidy approval. 

 

  1. Instructions for submitting subsidy invoices

Once your application is approved, you will be able to receive the subsidy from the date that you applied. Please follow this link:www.1stfinancialassociates.comto obtain specific information for submitting child care invoices.

  • First Financial Associates, Inc.(FFA) is the company who processes payments.  They have seven days from the date they receive your invoices to send the checks to your provider. 
  • Please email your invoices to:

First Financial Associates, Inc.

pscccsp@1stfinancialassociates.com

  • Stacey Royal is the point of contact for First Financial Associates, Inc.
  • Download the invoice for the OPDIV you are employed by. At the end of each month after services have been rendered, your provider will fill out the form.
  • Both you and your provider sign the form and send it to FFA. They will process the invoice and send the check directly to your provider. Payments are made monthly and it’s important to get them to FFA as soon as possible.
  • The amounts claimed need to be in weekly amounts, not monthly amounts.
  • Each month’s child care ends on the last Friday of the month you are claiming.
  • Please make sure you use the correct OPDIVform as it could hold up payments.
  • The invoice needs to be emailed to FFA.
  • Invoices that are not received within 10 business days of the deadline must be approved by the PSC Child Care Coordinator.

 

  1. Annual Recertification

Continued participation in the Employee Child Care Subsidy Program requires an annual recertification by April 30th each year.  The following information must be submitted to the PSC Child Care Coordinator.  It will then be reviewed, approved and forwarded to First Financial Associates, Inc.:

  • SF-50 must be submitted
  • Pay statements for the two most recent pay periods for each parent or guardian
  • Most recent signed[2]IRS Tax filing forms for each parent or guardian
  • W-2’s for each parent or guardian
  • Application Form - HHS-698
  • OPM -1644, Child Care Provider Form - Please note: Your provider does not need to fill out section IV Provider’s Financial Institution.
  • Copy of child care provider’s license or letter of compliance with state or local child care agency
  • Birth Certificate for each child
  • IRS W-9 to Verify Tax ID of Child Care Provider
  • Rate Sheet from Child Care Provider

 

  1. Changes in Enrollment

 

When you sign the HHS-698, you agree to inform the PSC Child Care Coordinator and First Financial Associates, Inc. of any changes in your information listed on the applications. 

 

OPM-1644, Child Provider Form – Please note:  Your provider does not need to fill out section IV Provider’s Financial Institution.

 

Please contact us if your provider has moved and provide the PSC Child Care Coordinator with a copy of the provider’s new license.

 

IRS W-9 to Verify Tax ID of Child Care Provider

 

Rate Sheet from Child Care Provider

 

  1. Changing Providers

 

            When you change providers, please submit the following to the PSC Child Care

 Coordinator:

 

  • a new OPM 1644 before you start care
  • a new HHS-698 – Application Form
  • copy of the new provider’s license
  • IRS W-9 to Verity Tax ID of Child Care Provider
  • Rate Sheet from Child Care Provider

 

  1. Summer Camp

 

The subsidy may be used for summer camp as long as the camp falls into the following categories:

 

  • a licensed facility
  • a letter of compliance
  • a certificate to operate as a summer camp
  • IRS W-9 to Verify Tax ID of Child Care Provider
  • Rate Sheet from Child Care Provider

 

For enrollmentguidance and further information on the SAMHSA Child Care Subsidy Program, please contact:

 

            Rebecca M. Donnelly, PSC Child Care Coordinator

            Rebecca.Donnelly@psc.hhs.gov

            301-492-4080(office)1-240-465-0217(fax)

 

 

Manually signed or proof of an electronic signature if e-filed.

 

 

 

 

 

 

 

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