If I choose Option 2 or 3, will I know which families receive the higher payment? No. By law, we cannot tell you the payment level of any child enrolled for care. We can tell you the number of children enrolled for care who qualify for the higher payment. Do I need to choose one of these options? Yes. You must choose one of these options (check the option of your choice below), sign and date this form, and return it to our office. What happens if I do not choose one of these options? If you do not choose an option, you will be paid for all meals at the lower Tier II payment rate until you complete and return this form. How long will it take to determine my rate of payment? It will take time for our agency to collect income-eligibility applications from families and make eligibility determinations. You will receive the higher Tier I payment rate as soon as we have evaluated the forms. Please choose your option and return the form to our office as soon as you can. Provider election of reimbursement option. (This selection will not change unless you submit a new option form to your sponsoring organization.) Option 1 Option 2* Option 3* *For Option 2 or 3, choose how families will get the Family Income-Eligibility Applications. Sponsoring organization mails all applications directly to the children’s homes. Provider gives applications directly to the children’s families with return envelopes addressed to the sponsoring organization. Signature of Provider Date Signature of Sponsoring Organization Representative Date
If I choose Option 2 or 3, will I know which families receive the higher payment? No. By law, we cannot tell you the payment level of any child enrolled for care. We can tell you the number of children enrolled for care who qualify for the higher payment. Do I need to choose one of these options? Yes. You must choose one of these options (check the option of your choice below), sign and date this form, and return it to our office. What happens if I do not choose one of these options? If you do not choose an option, you will be paid for all meals at the lower Tier II payment rate until you complete and return this form. How long will it take to determine my rate of payment? It will take time for our agency to collect income-eligibility applications from families and make eligibility determinations. You will receive the higher Tier I payment rate as soon as we have evaluated the forms. Please choose your option and return the form to our office as soon as you can. Provider election of reimbursement option. (This selection will not change unless you submit a new option form to your sponsoring organization.) Option 1 Option 2* Option 3* *For Option 2 or 3, choose how families will get the Family Income-Eligibility Applications. Sponsoring organization mails all applications directly to the children’s homes. Provider gives applications directly to the children’s families with return envelopes addressed to the sponsoring organization. Signature of Provider Date Signature of Sponsoring Organization Representative Date
2018-Option-Form.docx