Form sr 10 2025

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The document outlines the requirements for Group Homes or Foster Family Agencies in California to submit a Certification of Audited Cost Data, completed by a Certified Public Accountant (CPA). It specifies that this form is necessary if the CPA has not provided alternative documentation confirming that the cost data reports were audited and accurately represented. Additionally, it includes instructions for submission to the California Department of Social Services and emphasizes compliance with the False Claims Act.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the Group Home or Foster Family Agency corporate name in the designated field.
Input the program number(s) associated with your agency in the next section.
Fill in the street address, ensuring accuracy for correspondence.
Specify the program fiscal year using the format (MO/YR-MO/YR).
Provide your city, state, and zip code in the appropriate fields.
Enter your provider phone number for contact purposes.
Check all applicable forms: SR 3, SR 4, or FCR 12FFA as required.
The CPA should print their name and address, followed by their city, state, and zip code.
Finally, ensure that the CPA signs and dates the form before submission.

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2006	4.9 Satisfied (330 Votes)

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