Get the free (12/04) - Group Home Program Payroll & Fringe Benefit Report (SR 4) - cdss ca

STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES GROUP HOME PROGRAM PAYROLL & FRINGE BENEFIT REPORT (SR 4) Number of months in cost reporting period: CORPORATE/LICENSEE

How to fill out 1204 - group home

How to fill out 1204 - Group Home:

1. Start by gathering all the necessary information and documents required to complete the form. This may include details about the group home, its address, and the individuals residing there.
2. Begin filling out the form by providing the basic information such as the name of the group home, its contact information, and the date of the application.
3. Proceed to fill out the sections that require details about the individuals residing in the group home. This may include their names, dates of birth, and any specific medical or behavioral conditions they may have.
4. Ensure that you accurately fill out all the required information for each individual. It is important to double-check the details to avoid any errors or discrepancies.
5. Next, provide information about the staff or caregivers responsible for the group home. This may include their names, contact information, and any qualifications or certifications they possess.
6. In the following sections, you may need to provide additional details about the facilities and amenities available at the group home. This can include information about the number of bedrooms, bathrooms, common areas, and any specialized equipment or services provided.
7. Lastly, review the completed form for any mistakes or missing information. Make sure all the required fields are filled, and all the details provided are accurate and up to date.

Who needs 1204 - Group Home:

1. Individuals or organizations operating a group home facility may need to fill out Form 1204 - Group Home. This form is typically required by regulatory bodies or government agencies that oversee the licensing and monitoring of group homes.
2. Social service agencies that work with vulnerable populations, such as children or adults with disabilities, may also be required to fill out this form when referring individuals to a group home or when conducting regular assessments or evaluations.
3. Additionally, individuals seeking placement in a group home may need to provide information required on Form 1204. This can include individuals with special needs, those who require specialized care, or those who may benefit from the structured environment offered by a group home setting.

For pdfFiller’s FAQs

What is 1204 - group home?

1204 - group home is a form used to report information about group homes or residential care facilities.

Who is required to file 1204 - group home?

Any organization or individual operating a group home or residential care facility is required to file 1204 - group home.

How to fill out 1204 - group home?

To fill out 1204 - group home, you will need to provide information about the facility, such as location, number of residents, and services provided.

What is the purpose of 1204 - group home?

The purpose of 1204 - group home is to ensure that group homes and residential care facilities are properly regulated and monitored.

What information must be reported on 1204 - group home?

Information such as facility name, address, number of residents, type of services provided, and contact information must be reported on 1204 - group home.

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