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Title 13: Social Service Resources Page 109 Iowa Department of Health and Human Services Employees’ Manual Chapter G: Child Care Assistance Authorizing Services Revised June 14, 2024 Child Care Assistance Provider Agreement Child Care Assistance Provider Agreement Legal reference: 441 IAC 170.4(7) Policy: The Child Care Assistance Provider Agreement, form 470-3871, is the agreement between the child care provider and the Department. The same agreement is used for all Child Care Assistance (CCA) authorized through the Department or through Iowa Workforce Development (IWD) for PROMISE JOBS. Procedure: If the chosen provider does not already have an agreement on file, issue form 470-3871 to the provider or parent to secure the provider’s signature. In the agreement, the provider agrees to accept payment through the Department’s payment system and not to request additional payment from the parent, except for: ▪ The applicable fee found on the Notice of Decision. ▪ The difference between the CCA Program payment and the provider’s private pay rates, if agreed to by the parent and provider in writing prior to care being provided. The agreement provides that payment may be made to a provider for a child not in attendance for a maximum of four days per calendar month. Allow this payment when the child is regularly scheduled on those days and the provider also charges a private customer for days of absence. The Department may refuse to enter into or may revoke a Child Care Assistance Provider Agreement if: ▪ The Department finds there to be a hazard to the safety and well-being of a child and the provider cannot or refuses to correct the hazard. ▪ The provider has submitted claims for payment for which the provider is not entitled. ▪ The provider refuses or fails to cooperate with the Economic Fraud Control Unit of the Department of Investigations, Appeals and Licensure (DIAL). ▪ The provider does not provide a social security number or an employer identification number. ▪ The provider does not meet one of the applicable requirements found at Provider Requirements. ▪ The provider fails to comply with any of the terms and conditions of the Child Care Assistance Provider Agreement, form 470-3871 or 470-3871(S). ▪ The provider submits attendance documentation for payment and the provider knows or should have known the documentation is false or inaccurate.