The FIA-1100A E Pdf form is an essential document designed to verify an applicant or participant's work schedule for child care assistance under the Family Independence Administration. This form, part of a broader effort to streamline child care assistance, requires employers' verification to ensure the accurate accounting of work schedules, thereby justifying the need and hours of child care required. Interested individuals seeking child care assistance are encouraged to fill out this form thoroughly to support their application.
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Navigating the complexities of child care assistance through the Family Independence Administration (FIA) involves thorough documentation, particularly for those applying for or currently receiving Cash Assistance (CA) or Child Care in Lieu of Cash Assistance (CILOCA). Two essential forms in this process are the Work Schedule For Child Care (FIA-1100) and the Employer’s Verification (FIA-1100a), designed to verify the work schedules of applicants or participants, a requirement set by regulations and social service law to justify the need for child care hours. The revised policy bulletin, as outlined by the FIA, emphasizes the importance of these forms in the application and reevaluation phases for child care assistance, detailing specific scenarios where these documents are necessary, including changes in work schedule, employment status, and during initial applications or recertifications. For those employed by multiple employers, engaged in various work schedules, or acting as a child care provider themselves, the bulletin provides clear directives on how to accurately document and submit these schedules. This meticulous approach ensures that the assistance provided aligns precisely with the needs of the families it aims to support, making the verification process a cornerstone of the childcare assistance program.
FAMILY INDEPENDENCE ADMINISTRATION
Matthew Brune, Executive Deputy Commissioner
James K. Whelan, Deputy Commissioner
Stephen Fisher, Assistant Deputy Commissioner
Policy, Procedures, and Training
Office of Procedures
POLICY BULLETIN #13-80-OPE
(This Policy Bulletin Replaces PB # 13-77-OPE)
Date:
Subtopic(s):
September 13, 2013
Child Care
This procedure can Revision to the Original Policy Bulletin:
now be accessed on the
FIAweb.
This policy bulletin is being revised to clarify the use of the Work
Schedule For Child Care (FIA-1100) and the Employer’s Verification
(FIA-1100a) forms.
Purpose:
The purpose of the policy bulletin is to provide staff with information
on two child care forms, the Work Schedule For Child Care (FIA-
1100) and the Employer’s Verification (FIA-1100a). The FIA-1100 is
an attestation of the applicant’s/participant’s work schedule. The
FIA-1100a is the employer’s verification of the
applicant’s/participant’s work schedule. As required by regulations
and social service law, every applicant or participant who is
requesting child care assistance must provide his/her work schedule
to justify the hours of child care required.
The Child Care Return Appointment form (W-273NN) has been
revised to include the FIA-1100 and the FIA-1100a in the list of
forms to be returned at the child care return appointment.
The FIA-1100 and the
Every applicant/participant requesting child care whose hours of
FIA-1100a does not
employment is not controlled/monitored by the Family Independence
apply to individuals
Administration (FIA) (See list below) must complete and submit the
assigned to full-time
FIA-1100 in order to receive or continue receiving child care
WEP and B2W.
payments.
HAVE QUESTIONS ABOUT THIS PROCEDURE?
Call 718-557-1313 then press 3 at the prompt followed by 1 or send an e-mail to FIA Call Center Fax or fax to: (917) 639-0298
Distribution: X
If the FIA-1100 has been completed, the child care information can be entered into ACCIS if all of the appropriate provider forms are complete and approved by the enrollment agency, if required.
PB #13-80-OPE
The following individuals are required to complete an FIA-1100:
Individuals who are:
applying for Cash Assistance (CA) who report employment income.
receiving CA and report new employment income.
employed and report a permanent change in:
work hours (increase or decrease).
employment status (part time to full time or vice versa).
applying for or in receipt of Child Care in Lieu of Cash Assistance (CILOCA).
employed as a child care provider even if they are receiving payments through the Automated Child Care Information System (ACCIS).
Note: Individuals who provide a letter from the employer on the employer’s stationary with contact information that includes the
daily work schedule (i.e., M – F 9am – 5pm) are not required to complete the FIA-1100 or to have the employer complete the FIA-1100a.
The FIA-1100 and the FIA-1100a must be used at application and recertification and will be incorporated into the six month eligibility mailer process at a later date.
At the interview, the JOS/Worker must print the FIA-1100 and the
FIA-1100a. The applicant/participant must complete the FIA-1100 on the same day of the interview. If the applicant’s/participant’s work
schedule varies, he/she must enter the schedule most commonly worked. If there is a second employed parent or guardian of the child, his/her work schedule must also be captured on the same form in the “Work Schedule For Other Adults in Household” section. If the second employed parent or guardian is not present at the interview, the parent or guardian that is present must enter the information for that individual in the second part of the FIA-1100. The applicant/participant requesting child care must attest to both work schedules.
If the applicant/participant has a second employment, the Work Schedule For Other Adults in Household section on the FIA-1100 must be used to enter the hours for the second employment.
FIA Policy, Procedures, and Training
2
Individuals who are self- employed are not required to complete the FIA-1100a.
Please use Print on
Demand to obtain copies of forms.
If for any reason the applicant/participant cannot fill out the FIA-1100 while present at the interview (example: Applicant/participant is not sure what their permanent schedule will be because he/she just started working and is now in a training schedule.), the FIA-1100 can be completed and submitted at the child care return appointment. The JOS/Worker must ensure that the FIA-1100 is checked on the W-273NN.
Once the FIA-1100 is completed by the applicant/participant, it must be scanned and indexed into the POS case record. Child care cannot be authorized until the FIA-1100 is completed, signed and submitted.
The FIA-1100a must be given to the applicant/participant to take to the employer. One FIA-1100a must be given for each employer and for each parent/guardian. The JOS/Worker must make a five day child care return appointment in New York City Work Accountability and You (NYCWAY), check the FIA-1100a box on the W-273NN and give the form to the applicant/participant to return with the completed FIA-1100a and other child care provider forms, if required.
When the applicant/participant returns with the FIA-1100a completed by the employer, it must be scanned and indexed into the POS case record.
At the return appointment if the applicant/participant wishes to change the work schedule previously reported, a new FIA-1100 must be completed.
If the applicant/participant fails to return the FIA-1100a, the JOS/Worker must mail an FIA-1100a to the employer and enclose a business reply envelope. If the FIA-1100a is not returned, and the completed FIA-1100 is filed in the record, no adverse action will be taken.
Effective Immediately
Related Item:
PD #13-18-EMP
PD #13-19-ELI
Attachments:
FIA-1100
Work Schedule for Child Care
FIA-1100 (S) Work Schedule for Child Care (Spanish)
FIA-1100a Employer’s Verification
3
W-273NN
Child Care Return Appointment (Rev. 8/20/13)
W-273NN (S)
Child Care Return Appointment (Spanish)(Rev.
8/20/13)
4
FIA-1100 (E) 8/20/2013
LLF
Work Schedule For Child Care
If you wish to receive or already receive subsidized child care, in order to properly account for your child care needs, please complete this form with information about your employer and your work schedule. If your work schedule changes often, please provide your most commonly worked schedule. You must complete this form to receive child care.
Applicant/Participant's Name:
Cash Assistance Case Number:
Employer's Name:
Employer's Address:
Weekly Schedule
Days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Start Time:
End Time:
Total Weekly
hours worked:
Number of hours worked:
Total Weekly Travel Time: If your travel time varies each day, use your longest travel time and multiply by five (5).
For example: Two (2) days a week your travel time is two (2) hours, and three (3) days a week your travel time is one (1) hour, your total travel time should be 5x2 = 10 Hours.
Total Weekly Travel Time:
Work Schedule For Other Adults in Household
Relationship to Child:
Parent
Guardian
I swear or affirm that the Information on this form is true and correct.
Applicant/Participant’s Signature: ___________________________________________ Date: ____________________
FIA-1100 (S) 8/20/2013
Horario de Trabajo para Cuidado Infantil
Si usted desea recibir o ya está recibiendo cuidado infantil subvencionado, a fin de rendir cuenta de sus necesidades de cuidado infantil, favor de llenar este formulario con información sobre su empleador y su horario de trabajo. Si su horario de trabajo cambia a menudo, favor de proporcionar su horario más comúnmente trabajado. Usted debe llenar este formulario para recibir cuidado infantil.
Nombre del Solicitante/Participante:
Núm. del Caso de Asistencia en Efectivo:
Nombre del Empleador:
Dirección del Empleador:
Horario Semanal
Días
lunes
martes
miércoles
jueves
viernes
sábado
domingo
Hora de comienzo:
Total de Horas
Hora final:Trabajadas Semanales:
Número de
horas trabajadas:
Total del tiempo de viaje semanal: Si su tiempo de viaje varía cada día, use su tiempo de viaje más largo y multiplique por cinco (5). Por ejemplo: Dos (2) días a la semana usted viaja dos (2) horas, y tres (3) días a la semana, viaja una (1) hora, el total de su tiempo de viaje debe ser 5x2 = 10 Horas.
Total del Tiempo de Viaje:
Horario de Trabajo de Otros Adultos en el Hogar
Relación con el Niño:
Padre/madre
Tutor
Número de horas trabajadas:
Juro y afirmo que la información en este formulario es verídica y correcta.
Firma del Solicitante Participante:____________________________________________ Fecha: ________________
FIA-1100a (E) 08/20/2013
Employer’s Verification
Employee’s Name:
In order to receive New York City Child Care, your employee listed above must provide this agency with a work schedule verified by his/her employer. Please complete your employee’s work schedule in the spaces below. If your employee works a variable schedule, please fill in his/her most commonly worked schedule.
Employer’s Name:
Employer’s Address:
City:
State:
Zip Code:
Hours Worked
Number of
The above schedule is (please check one):
Standard
Variable
Employer or Employer Designee’s Signature: _______
________________________ Date: ___________________
Title:
Phone number:
_______
Form W-273NN LLF
Rev. 8/20/13
Case Number:
Case Name:
Job Center:
Child Care Return Appointment
Please return for the following reason(s)
I. CHILD CARE IS NEEDED
133S (Participant/Sanctioned Individual)
933S (Applicant)
Documents required:
II.ADDITIONAL INFORMATION IS NEEDED 133D (Participant/Sanctioned Individual)
Check the boxes that apply
Complete and return the child care provider enrollment form(s) provided Secure and return all documentation listed
933D (Applicant)
Check the boxes that apply LDSS-4699
LDSS-4700
CS-274W
FIA-1100
FIA-1100a
I will bring the above-mentioned documentation with me to my new appointment.
I will return to this mandatory engagement appointment on:
Appointment Date:
Time:
Telephone:
Address:
Zip:
This is a mandatory engagement appointment. Failure to keep this appointment may result in a reduction in your Cash Assistance and/or SNAP benefits. Please call the telephone number above if you need to reschedule this appointment.
You must report to the Job Center with this form.
Applicant's/Participant's/Sanctioned Individual's Signature
Date
Form W-273NN (S) LLF
Fecha:
Número del Caso:
Nombre del Caso:
Centro de Trabajo:
Cita de Vuelta de Cuidado Infantil
Favor de regresar por la(s) siguiente(s) razón(es)
I. SE NECESITA CUIDADO INFANTIL
133S (Participante/Persona Sancionado[a])
933S (Solicitante)
Documentos necesarios:
II. SE NECESITA INFORMACIÓN ADICIONAL
133D (Participante/Persona Sancionado[a])
Marque las casillas que correspondan
Llene y devuelva el formulario(s) de inscripción del proveedor de cuidado infantil
Consiga y devuelva toda la documentación listada
933D (Solicitante)
Marque las casillas que correspondan LDSS-4699
FIA-1100
FIA-1100a
Traeré toda la documentación mencionada más arriba a mi nueva cita.
Regresaré a esta cita de participación obligatoria el:
Fecha de la Cita:
Hora:
Teléfono:
Dirección:
Ciudad:
Estado:
Código Postal:
Ésta es una cita de participación obligatoria. El no cumplir con esta cita puede resultar en una reducción de sus beneficios de Asistencia en Efectivo y/o SNAP. Favor de llamar al número de teléfono más arriba si necesita reprogramar esta cita.
Usted tiene que presentarse al Centro de Trabajo con este formulario.
Firma del Solicitante/Participante/Persona Sancionado(a)
Fecha
Filling out the FIA-1100A E form is an essential step for those seeking to obtain or maintain their subsidized child care benefits. It serves to detail one's work schedule, crucial for calculating the necessary amount of child care support. The process involves accurately providing personal employment information and, if applicable, details regarding other adult household members' employment schedules. The following instructions guide individuals through each required section, ensuring clarity and accuracy to avoid delays or complications in receiving child care assistance.
Upon completion, the FIA-1100A E form becomes a critical document in establishing your eligibility and need for subsidized child care. It's vital to submit this form promptly, along with any additional required documents, to ensure uninterrupted child care assistance. Accurate and thorough completion assists in a seamless process, benefiting both applicants and the administering agency in upholding the highest service standards.
What is the purpose of the FIA-1100A form?
The FIA-1100A form, also known as the Employer’s Verification form, is designed to verify the work schedule of an applicant or participant requesting child care assistance. It must be completed by the employer to confirm the applicant's/participant's work hours, thereby justifying the need for child care hours as per the regulations and social service law. This form plays a crucial role in the application and recertification processes for child care assistance.
Who needs to complete the FIA-1100 and the FIA-1100A forms?
These forms must be completed by individuals applying for Cash Assistance (CA) who report employment income, those receiving CA and reporting new employment income, and individuals experiencing a permanent change in their work hours or employment status. Additionally, these forms are required from applicants or recipients of Child Care in Lieu of Cash Assistance (CILOCA) and employed child care providers receiving Automated Child Care Information System (ACCIS) payments. A letter from the employer with the work schedule can replace the need for these forms only in specific circumstances.
Can self-employed individuals bypass the FIA-1100A requirement?
Yes, individuals who are self-employed are not required to have the FIA-1100A form completed. The policy acknowledges the different nature of self-employment and omits the requirement for employer verification in such cases.
What happens if an applicant/participant cannot complete the FIA-1100 at the interview?
If an applicant or participant is unable to fill out the FIA-1100 during their interview due to uncertainties about their work schedule, they are allowed to complete and submit the form at a later child care return appointment. This flexibility accommodates individuals who may have recently started a job and are not yet aware of their permanent schedule.
What should be done with the FIA-1100A form?
The applicant or participant must give the FIA-1100A form to their employer for completion. This form must be filled out for each employer and each parent or guardian involved. After the employer completes the form, it must be returned and scanned into the POS case record by the staff at the return appointment.
Is there a specific time frame within which the FIA-1100A needs to be submitted?
While the exact time frame is not specified, it is implied that the FIA-1100A form should be submitted promptly after the interview or upon the completion of the FIA-1100. A five-day child care return appointment is usually scheduled to facilitate the collection of this and other required documents.
What happens if the FIA-1100A is not returned?
If the applicant or participant fails to return the completed FIA-1100A, the staff is instructed to mail the form directly to the employer with a business reply envelope. If the form is still not returned but the completed FIA-1100 is filed in the record, no adverse action will be taken against the applicant or participant regarding their child care request.
Can adjustments be made to the work schedule reported on the FIA-1100 after submission?
Yes, adjustments can be made. If an applicant or participant wishes to change the work schedule previously reported, they must complete a new FIA-1100 form with the updated information. This ensures that child care assistance accurately reflects their current employment situation.
When filling out the FIA-1100A form for child care assistance, individuals often make mistakes that can delay or jeopardize their application. One common error is failing to accurately report the work schedule. Applicants must provide a detailed account of their weekly work hours, including start and end times for each day. Omitting this information or providing a vague schedule can result in processing delays.
Another frequent mistake is not accounting for travel time. The form requires applicants to include the time it takes to travel to and from work. Many overlook this section or underestimate their daily commute. For accuracy, the form advises using the longest travel time and multiplying it by five. Neglecting to accurately calculate travel time can lead to an underestimation of total child care needs.
Inaccuracies or inconsistencies in reporting employment information are also common pitfalls. The employer's name and address must be precise, matching any official documentation that might be cross-referenced. A discrepancy here can raise questions about the validity of the application.
For households with more than one working adult, not including the work schedule of each working parent or guardian is a notable oversight. The form has a section specifically designed to capture this data. Failure to complete this section for both adults undermines the application's completeness, potentially leading to insufficient child care coverage.
Submitting the form without the required signatures is another error. Both the applicant's signature and the date are necessary for the form to be processed. An unsigned form is considered incomplete, stalling the application process until this oversight is rectified.
Lastly, applicants sometimes overlook the need to update the form when there are changes in their work schedule. Any alterations, whether it’s an increase or decrease in hours or a change in employment status, need to be communicated promptly. Maintaining an updated record ensures that child care assistance aligns with current needs.
When managing child care benefits and ensuring your eligibility, the FIA-1100 and FIA-1100a forms play a significant role, especially for those involved in employment while receiving aid. However, to navigate through the process efficiently and comply with all requirements, several other documents often accompany these forms. Familiarizing oneself with these additional forms not only facilitates a smoother process but also ensures that all potential benefits are accessed and secured without undue delay.
Securing child care support involves more than just submitting a work schedule for verification. A comprehensive approach, encompassing all facets of an applicant's work and financial status, is required. Through careful and complete submission of the FIA-1100A E Pdf form alongside the relevant supporting documents, applicants can effectively demonstrate their eligibility, streamline the approval process, and ensure that their child care needs are met in accordance with their employment and financial situation. Understanding and preparing each related document is therefore crucial for a successful application.
The FIA-1100A Employer’s Verification is closely related to the I-9 Employment Eligibility Verification form. Both documents require employer verification, albeit for different purposes. The I-9 form is used to verify the legal authorization of an employee to work in the United States, ensuring compliance with federal laws. In contrast, the FIA-1100A is aimed at verifying an employee's work schedule to qualify for child care assistance. Despite their different end goals, each form relies on employer confirmation to validate crucial information related to an employee's work status.
Another similar document is the Employment Verification Letter. Like the FIA-1100A, this letter serves as a formal method of verifying an employee's status, income, or hours worked directly from the employer. It is often used for loan applications, rental agreements, or similar situations where proof of employment or income is required. Both documents share the common feature of providing third-party verification of an employee’s work-related details, although the specific information and purpose behind their use may differ.
The Request for Verification of Employment (VOE) form also shares similarities with the FIA-1100A. The VOE is typically used by lenders to verify an applicant's employment and income when applying for a loan. It requests details on the employee's position, salary, and employment history. While the primary focus of the VOE is on financial eligibility for loans, paralleling the FIA-1100A's role in establishing eligibility for child care assistance based on work hours and schedule.
The Timesheet or Work Schedule Form used by many organizations to track employee hours worked is akin to the FIA-1100A. These documents are tools for recording the specifics of one's work schedule, including days worked and shift times. While a standard timesheet may not require employer verification in the same manner as the FIA-1100A, both serve to document the hours an employee is engaged in work-related activities, albeit for different administrative purposes.
Similarly, the Child Care Subsidy Application form, which families complete to request financial assistance for child care costs, echoes aspects of the FIA-1100A. Both require detailed information about the applicant’s employment situation to determine eligibility and need for assistance. While the subsidy application is more comprehensive, focusing on financial need and family composition, the inclusion of work schedule verification aligns it closely with the purpose of the FIA-1100A form.
Last, the Unemployment Benefits Application is another document with conceptual overlaps to the FIA-1100A. Applicants for unemployment must often provide detailed past employment history, including reasons for leaving and hours worked, similar to how the FIA-1100A requires current work schedule verification. Both processes aim to assess the applicant’s current or past employment status to determine eligibility for benefits or services, focusing on verifying the validity of the information provided.
When filling out the FIA-1100A E PDF form, here are some helpful guidelines to ensure the process is smooth and accurate.
Things You Should Do:
Provide accurate and complete information about your employment and work schedule, as well as the work schedule of other adults in the household if applicable. This helps to accurately assess your child care needs.
Use the most commonly worked schedule if your work hours vary. By doing this, you allow for a more consistent evaluation of the child care assistance required.
Sign and date the form. Your signature is essential as it verifies that the information provided is true and correct to the best of your knowledge.
Fill out the form at the time of your interview, if possible. Completing it during your interview can expedite the processing of your application for child care assistance.
Things You Shouldn't Do:
Leave sections blank. If certain sections do not apply to you, write “N/A” (not applicable) to ensure that all parts of the form have been considered and addressed.
Guess your work schedule. Providing guesses instead of actual or most common schedules can lead to inaccuracies in the assistance provided.
Forget to include travel time. Your total weekly travel time is a crucial component of assessing your child care needs, so make sure to calculate and include it.
Ignore the need for the employer's verification if employed by others. The form requires the employer’s verification for a reason – to validate the work schedule you’ve provided.
There are several misconceptions about the FIA-1100A E PDF form that need to be addressed for a clear understanding of its purpose and requirements. Below is a list of common misconceptions and factual explanations to dispel them:
It's only for those who apply for Cash Assistance (CA): While it's true that applicants for CA who report employment income must complete the FIA-1100A, the requirement also extends to current CA recipients reporting new employment, those experiencing a permanent change in work hours or employment status, applicants or recipients of Child Care in Lieu of Cash Assistance (CILOCA), and child care providers being paid through the Automated Child Care Information System (ACCIS).
Employer's Verification (FIA-1100a) is always necessary: This is not the case for individuals who are self-employed, as they are not required to have the employer complete the FIA-1100a form.
Any letter from an employer is sufficient for verification: Only a letter from the employer on the employer’s stationery that includes contact information along with the daily work schedule will suffice in lieu of the FIA-1100 or FIA-1100a forms.
It's a one-time requirement: The forms must be used at application and recertification and will later be incorporated into the six-month eligibility mailer process.
It can be delayed until after the interview: The applicant/participant must complete the FIA-1100 on the same day of the interview unless there is an uncertainty about their permanent schedule due to reasons such as a new job training schedule, in which case it can be completed at the child care return appointment.
It applies to individuals assigned to full-time Work Experience Program (WEP) and Back to Work (B2W) programs: Individuals whose hours of employment are controlled/monitored by the Family Independence Administration (FIA) and those assigned to full-time WEP and B2W are not required to submit these forms.
A new form is not necessary for a change in work schedule: At the return appointment, if the applicant/participant wishes to report a change in the previously reported work schedule, a new FIA-1100 must be completed.
Failure to submit the FIA-1100a will result in immediate adverse action: If the applicant/participant fails to return the completed FIA-1100a, the JOS/Worker will mail an FIA-1100a to the employer and include a business reply envelope. No adverse action will be taken as long as the completed FIA-1100 is filed in the record.
The form must be mailed for completion: The policy encourages utilizing Print on Demand to obtain copies of the form, and the FIA-1100a must be given to the applicant/participant to take to their employer for completion, thus ensuring the process is expedited effectively.
Understanding these points correctly is vital to ensure proper compliance with child care assistance requirements and avoid unnecessary complications in the application or recertification processes.
Filling out and using the FIA-1100A (Employer's Verification) form accurately and conscientially is critical for those requesting child care assistance through social services. There are several important facets to keep in mind:
In conclusion, the FIA-1100 and FIA-1100A forms serve as essential instruments in the administration of child care assistance, demanding attention to detail and accurate reporting by all applicants. These procedural requirements ensure that the Family Independence Administration can make informed decisions regarding child care subsidies, facilitating support tailored to the specific needs of working families.
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