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Child Care Subsidy Policy October 1, 2024 133 14.4.48 ECE-CC-31 Guide to Family Child Care Child care regulatory specialists and CCR&R case managers may send this booklet to potential providers interested in becoming family child care providers. 14.5. Miscellaneous Forms and PATH Reports 14.5.1. DAY-0616 History of Non-Compliance Report This report shall be generated by PATH upon request of a parent who requests information on substantiated complaints against the provider that are a matter of public record. The History of Non-compliance Report may be sorted by dates or by concerns identified during licensing review, monitoring visits or because of an investigation or a complaint investigation. Information on child abuse and neglect complaints shall not be included for distribution. 14.5.2. ECE-CC-20 IIU Referral Interview Guide CCR&R and DoHS staff can use this form as a guide for recording child abuse and neglect complaints on child care centers. 14.5.3. ECE-CC-21 Protective Services Referral Interview Guide CCR&R and DoHS staff can use this form as a guide for recording child abuse and neglect complaints on any type of child care provider other than child care centers. 14.5.4. IG-BR-29 Hearing/Grievance Record Information Form This form is to be completed by the case manager when a client requests a hearing regarding a negative action decision on a case. The request is to be sent within 48 hours to the WV DoHS Office of OIG with the appropriate documentation. 14.5.5. ECE-CC-19 Child Care Repayment Agreement. This form shall be completed whenever a provider or client is determined to have received services or payments to which they were not entitled, and the CCR&R is negotiating for repayment. The form shall be signed in duplicate, with one copy given to the client or provider and the other retained in the appropriate record. A copy shall also be sent to: Division of Accounting and Reporting Office of Operations WV DoHS Bureau for Family Assistance 350 Capitol Street Suite 730 Charleston WV 25301-3711 14.5.6. ECE-68 Remittances to Local DoHS Offices CCR&R staff shall complete this form on any returned checks or any re-payments that come into the CCR&R office. All items shall be completed. To enter the fund code, please look at the client payment history in PATH which shows one of two fund types indicated below. The fund code for that type is in the right-hand column in the chart below. Fund Type Fund Code