Dpp 106a Form

Instructions and help about Dpp 106a Form

this is the current Department of Child Safety billing form for children placed in both licensed and unlicensed foster care all the information must be correct to ensure proper payment the placements information that Cu the foster parent is in the top right and bottom right corners the information on each shaded line is what the Arizona Department of Child Safety has in the system for the child the participant ID number child's name dates the child was in the home for that month service authorization classification and number of units or days the child was placed with you our most important if any of the information is incorrect the placement must draw a line to the incorrect info and write the correct info on the blank line directly below the same column irregardless of any changes you must write the number of units used under the type number if there were no Corrections these numbers will be the same if not they should be corrected you will not be paid unless you verify the numbers i