Form ca 16 2025

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4.3 out of 5

185 votes

The document is a survey and declaration form from the California Department of Social Services regarding group home shelter costs and self-dealing transactions. It requires licensed group home providers to report on their facilities, including ownership status and any self-dealing transactions involving board members or their families. The form emphasizes compliance with state regulations to ensure eligibility for funding rates, and it must be signed by an authorized board officer.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Licensee/Corporate Name and Program Number at the top of the form. If you are a new provider, leave the Program Number blank.
Fill in your Mailing Address, E-Mail Address, Contact Person, and Telephone Number. Ensure all information is current and accurate.
For Line 1, enter the number of facilities currently licensed and pending licensure under your corporate name for this group home program.
Continue with Line 2 by indicating the number of facilities owned by your corporation that have clear title or a mortgage/deed of trust.
On Line 3, specify the number of facilities with a rental or lease agreement. Break this down into Lines 3a and 3b for self-dealing transactions as instructed.
Complete Line 4 by answering whether there are any other shelter costs resulting from self-dealing transactions. Provide details if applicable.
Finally, ensure to sign the certification section at the end of the form before submitting it via mail to the California Department of Social Services.

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2015	4.8 Satisfied (251 Votes)
2009	4.3 Satisfied (185 Votes)

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What is a CA 16 form?

What You Shouldnt Tell Your Workers Comp Doctor Never lie about prior injuries, pre-existing conditions, or medical history. Never lie about the extent of your workplace injury or how it happened. Do not exaggerate your symptoms, including pain or functionality.

How does buying back leave work?

On an annual basis, the California Department of Human Resources (CalHR) will determine whether or not the Program will be offered. Eligible employees may receive payment at their regular salary rate in exchange for accrued vacation, annual leave, personal leave, and/or personal holiday credits.

How does the federal buyout work?

The Voluntary Separation Incentive Payment Authority, also known as buyout authority, allows agencies that are downsizing or restructuring to offer employees lump-sum payments up to $25,000 as an incentive to voluntarily separate.

How does federal buy-back work?

Creditable Military Service Buy-Back for FERS Federal employees who are veterans can receive retirement credit for military service once they make a deposit into a civilian annuity covering their military service. The deposit will be processed through your agencys Personnel or Human Resources Office.

What does leave buy-back mean?

Leave buy-back allows employees to receive cash payment in exchange for applicable leave credits. The California Department of Human Resources (CalHR) may authorize an annual Excluded Employee Leave Buy-Back Program (Program) and will notify departments of the opportunity to participate.

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What not to say to a workers comp doctor?

Things to Know About Leave Buy Back: In order for leave to be reinstated, the employee must refund to the agency the difference between the compensation entitlement and the total amount of leave paid by the agency. The employees pay status must be changed to LWOP in order for compensation to be paid.

How does the federal leave buy back work?

The CA-17 was designed to provide the doctor with an accurate description of the physical work requirements of the injured letter carrier. The CA-17 is a legal document that determines both an injured workers medical restrictions and entitlement to wage-loss compensation benefits.