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The California 836 Form plays a crucial role in determining the financial support available for children and youth involved in the foster care or adoption systems. This important document is primarily used to assess a child's eligibility for supplementary financial assistance, which can be essential in meeting the unique needs of each child. Designed for children aged three years and older, the form requires specific details such as the child's name, age, and crucial dates, including when the form was completed and when the request for the supplement was made. A vital component of the approval process involves a rate chart where a county child welfare or adoption worker must indicate the responses to a set of yes or no questions. Each affirmative answer correlates with a potential financial supplement, which may vary based on how many questions receive a positive response. Depending on the total number of positive responses, the approved supplement can reach a maximum of $1,000. Additionally, the form mandates the inclusion of pertinent identification information such as the name, contact information, and signature of the person completing the document. Through this structured approach, the 836 Form aims to provide a standardized method for assessing and allocating financial support for children in need, thereby ensuring that they receive necessary resources for their care and development.

836 Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

SUPPLEMENT TO THE RATE ELIGIBILITY FORM

NAME OF CHILD/YOUTH:

AGE OF CHILD/YOUTH (SUPPLEMENT FOR CHILDREN THREE (3) YEARS OF AGE AND OLDER):

DATE FORM COMPLETED:

DATE OF REQUEST FOR SUPPLEMENT:

The county child welfare services worker or the adoption worker must complete the following rate chart by checking the number(s) that correspond with all YES answers using the completed Questionnaire(s). A

child may be eligible for a supplement to the rate reflected in any of the three boxes below. The supplement to the rate must not exceed one thousand ($1,000) dollars.

Rate Chart

Check all yes answers

 

 

1,

3,

5,

6,

9,

10

 

 

 

 

 

Yes answer to any one of the above questions =

 

$1,000

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2,

4,

7,

8

 

 

 

Check all yes answers

 

 

Yes answer to any four of the above questions =

 

$1,000

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes answer to any three of the above questions =

$750

 

 

 

 

 

Yes answer to any two of the above questions =

 

$500

 

 

 

 

 

Yes answer to any one of the above questions =

 

$250

 

 

 

 

 

 

 

 

 

OR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11a,

11b,

2,

4,

7,

8

 

 

 

 

 

Yes answer to 11(a) and any one of the above questions =

$1,000

Check all yes answers

 

 

Yes answer to 11(b) and any two of the above questions =

$1,000

 

 

 

 

Yes answer to 11(b) and any one of the above questions =

$750

 

 

 

 

Yes answer to 11(a)

= $750

 

 

 

 

 

 

 

 

 

 

 

Yes answer to 11(b) = $500

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPPLEMENT AMOUNT APPROVED:

 

 

 

 

 

 

EFFECTIVE DATE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF APPROVAL:

 

 

 

 

 

 

 

DATE OF DENIAL:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRINTED NAME OF PERSON COMPLETING THIS FORM:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE:

 

 

PHONE:

 

 

 

FAX:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGENCY NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(CHECK ONE)

SOCIAL SERVICES

ADOPTION

PROBATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE:

 

 

 

 

 

 

 

 

 

 

 

 

SOC 836 (11/08)

Form Characteristics

Fact Name Details
Governing Agency California Department of Social Services
Purpose of the Form This form serves as a supplement to the rate eligibility for children and youth under the California child welfare system.
Eligibility Criteria Eligibility is based on the answers provided in a completed Questionnaire, with specific criteria determining the supplement amount.
Supplement Amount The maximum supplement amount that may be awarded is $1,000, with tiered amounts for various eligibility answers.
Age Requirement The form is applicable for children three (3) years of age and older.
Completing Authority The county child welfare services worker or the adoption worker is responsible for completing the form.
Approval Timeline Sections for approval and denial dates must be filled out to track the review process of the supplement request.
Version of the Form The current version of the form is identified as SOC 836 (11/08).

Guidelines on Utilizing 836

Completing the 836 form is a straightforward process that aids in determining the eligibility for financial supplements related to child welfare services. Ensure you have all necessary information before starting. Follow these steps carefully for accurate completion.

  1. State the name of the child/youth: Enter the full name in the designated space provided.
  2. Provide age: Specify the age of the child/youth, ensuring this is for children three years of age and older.
  3. Date form completed: Write the date you are filling out the form.
  4. Date of request for supplement: Indicate the date you are requesting the supplement.
  5. Rate chart completion: The county child welfare services worker or the adoption worker should check the numbers that correspond with all "YES" answers from the completed questionnaires.
  6. Calculate supplement amount: Based on the checked answers, determine the supplement amount using the criteria provided in the rate chart.
  7. Supplement amount approved: Write the approved supplemental amount here.
  8. Effective date: Fill in the date the supplement is effective.
  9. Date of approval: Record the date when the supplement was approved.
  10. Date of denial: If applicable, enter the date of the denial.
  11. Printed name of person completing this form: Clearly print your name.
  12. Date: Put the date you completed the form.
  13. Phone and fax: Provide your contact number and fax number.
  14. Agency name: Check the appropriate agency type (Social Services, Adoption, or Probation).
  15. Address: Fill in the complete address of the agency.
  16. Signature: Sign the form to confirm its accuracy.

What You Should Know About This Form

What is the purpose of the 836 form?

The 836 form, also known as the Supplement to the Rate Eligibility Form, is used in California to determine if children and youth may qualify for additional financial support based on specific needs or circumstances. This ensures that they receive the necessary assistance for their care and well-being.

Who is required to complete the 836 form?

The 836 form must be completed by the county child welfare services worker or the adoption worker. They gather the required information to evaluate the child's eligibility for a supplemental rate.

What information is needed to fill out the form?

Essential information includes the name and age of the child or youth, the date the form is completed, and the date of the request for the supplement. Additionally, the worker will check the appropriate boxes based on responses to a set of questionnaires.

How is the supplement amount determined?

The supplement amount is based on a rating chart that is answered by checking off the number of “yes” responses. Depending on the combination of those responses, the child may qualify for varying supplement amounts up to $1,000.

What happens if a child answers 'yes' to multiple questions?

The answers to specific questions are assigned points which determine the amount of the supplement. For example, answering ‘yes’ to certain questions may qualify a child for the full $1,000 or a lesser amount based on the number of affirmatives provided.

Are there any limits to the supplement amount?

Yes, the maximum supplement amount cannot exceed $1,000. Furthermore, the amount awarded depends on the specific criteria met through the questions answered.

What information must be provided regarding the approval process?

The form requires the effective date of the supplement, the date of approval, and the date of denial, if applicable. This documentation helps track the process and any decisions made regarding the supplement.

How can I get assistance in filling out the 836 form?

If you need help, it is advisable to contact the agency that is responsible for the child’s care. The assigned caseworker or agency representative should be able to provide guidance and support while completing the form.

What should I do if my supplement request is denied?

If your request is denied, the denial date will be noted on the form. You are encouraged to follow up with your caseworker to understand the reasons for the denial and whether an appeal or resubmission is possible.

Where do I submit the completed 836 form?

The completed form should be submitted to the relevant agency, which can include social services, adoption agencies, or probation departments, depending on the child's circumstances.

Common mistakes

Completing the 836 form can seem daunting, but avoiding common mistakes can make the process smoother. One frequent error is not filling in all required fields. Each section gathers important information that helps determine eligibility. Skipping sections can lead to delays or denials, so ensure you read through the form carefully and provide all necessary details.

Another common pitfall occurs with the rate chart section. Many overlook the specific instructions on how to calculate the supplement amount. It’s essential to check the correct boxes corresponding with all "YES" answers. Making an incorrect selection could affect the final supplement amount. Take your time to double-check your answers before finalizing the form.

Additionally, not dating the form properly is a mistake many people make. Each date on the form tells a story—when the form was completed and when the request was submitted. Inaccurate dates can cause confusion and may lead to further inquiries. Be sure to provide the correct dates in the appropriate spaces.

Some individuals also forget to include contact information. Leaving out your phone number or agency name can complicate the approval process. This information allows the reviewing agency to reach you for any clarifications or follow-ups. Always include complete contact details so that communication remains seamless.

Moreover, be aware of the significance of signatures. Incomplete signatures can lead to processing delays. The form requires the signature of the person completing it, which confirms all information provided is accurate. Ensure you sign the form before submission to avoid unnecessary holdups.

A common error lies in not attaching the accompanying documentation, such as questionnaires. The 836 form often requires supporting documents to validate the answers given. Failing to include these can result in denial of the supplement request. Gather all necessary paperwork beforehand to enhance your form's completeness.

People also underestimate the importance of legibility. If the writing is unclear, it can lead to misinterpretations. Take care to write legibly or consider typing the information when possible. This will help ensure that all details are clear and easily understood by the agency reviewing the form.

Many forget to keep a copy of the completed form for their records. This is a vital step that is often overlooked. Having a copy can be incredibly helpful if you need to reference the information in future interactions with the agency. Always make a copy of any official document you submit.

Lastly, be mindful of deadlines. Failing to submit the form within the required timeframe can result in rejection of the request. Keep track of deadlines to ensure your application is submitted in a timely manner. Planning ahead can help you avoid last-minute rushes and possible errors.

Documents used along the form

The SOC 836 form is crucial for assessing the eligibility of children and youth for supplemental rates in California's welfare system. However, it is often accompanied by several other forms and documents that support the evaluation process. Below is a list of additional forms commonly used in conjunction with the SOC 836, each playing a distinct role in the overall application and approval process.

  • Questionnaire for Rate Eligibility: This document gathers detailed information regarding a child's needs, behaviors, and circumstances. It helps determine supplementary rate eligibility by providing context to the answers checked on the SOC 836 form.
  • Recommendation for Rate Adjustment: This is a formal document prepared by a social worker or case manager outlining reasons for recommending a specific supplemental rate. It often includes anecdotal evidence and expert opinions supporting the proposed change.
  • Income Verification Form: This form collects information about the financial situation of the household. It is essential for determining the financial eligibility of the family involved in the child welfare case.
  • Acknowledgement of Receipt: This document serves to confirm that the interested parties, such as caregivers or parents, have received important information regarding their rights and responsibilities as well as information about the supplement request process.
  • Case Plan: This comprehensive document outlines the goals, services, and interventions that are planned for the child. It ensures that everyone involved, including workers and caregivers, is on the same page regarding the child’s needs and the support provided.
  • Final Decision Letter: Once the SOC 836 and supporting documents are reviewed, this letter communicates the outcome of the application. It specifies whether the supplement was approved or denied, and it provides reasoning for the decision.

Each of these documents contributes to a thorough understanding of the child’s situation and needs. Their collective use facilitates informed decision-making in the welfare system, ensuring that children receive appropriate support and care.

Similar forms

  • I-130 Petition for Alien Relative: Similar to the 836 form, the I-130 helps establish a qualifying family relationship, ensuring that dependents receive necessary support. Both documents require thorough information about the individual being petitioned for and their background.

  • Form 990: This form documents financial information for non-profits, similar to how the 836 assesses a child's financial eligibility for services. Both forms aim to evaluate the financial aspects relevant to the respective assistance.

  • Franchise Tax Board Form 540: Just as the 836 confirms eligibility for a support supplement, Form 540 determines tax liability and credits for California residents. Both documents include important eligibility criteria to ascertain the correct amount of aid.

  • Application for CalFresh: Like the 836 form, this application determines whether an individual qualifies for nutritional assistance. Each requires personal details and information about circumstances that justify the request for additional support.

  • Child Care Application: This application assesses eligibility for child care subsidies, much like the 836 form evaluates eligibility for financial supplements. Both emphasize providing support based on the child's needs and family situation.

  • Welfare and Institutions Code 300 Petition: This document seeks to determine a child's eligibility for protective services. Similar to the 836, it addresses the unique needs of children and how those needs qualify them for specific types of care or financial support.

  • Form 1040: While primarily a tax return, the information gathered through the Form 1040 can demonstrate a family's financial standing, akin to the requirements of the 836. Both documents capture essential financial details necessary for approval of resources.

  • Temporary Assistance for Needy Families (TANF) Application: This application assesses the need for cash assistance based on family size and income. The 836 form does similarly by evaluating a child's eligibility for financial supplements based on individual circumstances.

Dos and Don'ts

When tackling the 836 form, there are certain best practices to ensure the process goes smoothly. Here are seven essential dos and don'ts to keep in mind:

  • Do double-check the child's name and age. Accurate information is crucial for proper eligibility determination.
  • Do maintain clarity by checking the correct answers on the rate chart. Make sure your selections reflect the responses from the completed questionnaires.
  • Do sign and date the form before submission. An unsigned form can lead to delays or denials.
  • Do provide accurate contact information, including phone and fax numbers. This will facilitate communication regarding the approval process.
  • Don’t leave any sections blank. Each question must be addressed to avoid confusion and to ensure a complete review of the application.
  • Don’t submit outdated versions of the form. Always use the most recent form available to avoid processing issues.
  • Don’t ignore the effective date and other time-sensitive details. These can impact the amount approved and the overall process.

By following these guidelines, you can increase the chances of a successful application process and ensure that all pertinent information is accurately conveyed on the 836 form.

Misconceptions

Misconceptions can often lead to confusion regarding the 836 form used in California. Here is a list of common misunderstandings.

  • It is only for children under three years old. The 836 form is specifically a supplement for children aged three years and older.
  • Completing the form guarantees approval. Submitting the form does not guarantee that the request for a supplement will be approved.
  • Only social workers can fill out the form. While a county child welfare services worker or adoption worker must complete the form, it can also be assisted by other responsible adults involved in the process.
  • The maximum supplement amount is fixed. The amount can vary based on the answered questions on the rate chart, with maximums ranging from $250 to $1,000.
  • All questions must be answered positively for maximum benefits. The chart allows for a combination of different 'yes' answers, providing several tiers of compensation.
  • It is a complex form that requires legal training to understand. The form is designed to be straightforward and user-friendly, allowing most people to comprehend its requirements.
  • Submission deadlines are flexible. There are specific timelines for submission that must be followed to ensure eligibility for the supplement.
  • Approval can occur any time after submission. The effective date of the supplement and the approval date are specified, which may affect when benefits are applied.

Understanding these misconceptions can help streamline the process for families seeking assistance. Accurate and timely submissions of the 836 form can improve the likelihood of receiving the necessary support.

Key takeaways

Understanding how to fill out and use the 836 form is essential for ensuring that a child or youth receives the appropriate financial support. Here are some key points to consider:

  • The 836 form is intended for children three years of age and older who may need supplemental financial assistance.
  • Accurate information is crucial. Make sure to complete all required sections, including the child's name, age, and date of request.
  • The county child welfare services worker or adoption worker must fill in the form based on completed questionnaires.
  • The rate chart is pivotal. It determines the supplement amount by checking "yes" answers according to specific questions.
  • Eligibility for a supplement can be up to $1,000, depending on the number of "yes" answers given.
  • A variety of scenarios dictate the supplement amount. For example, answering "yes" to multiple questions allows for more significant funding.
  • Ensure to keep a record of the effective date and any approval or denial dates for future reference.
  • The printed name and contact information of the person completing the form must be included for clarity.
  • Filing the form correctly can significantly impact a child’s well-being and access to needed resources.
  • Lastly, it is essential to follow up with the appropriate agency if there are any delays or questions regarding the approval process.