Form 1 Improper Payments DCI - Sampling Decisions, Assurances,

OMB Control Number: 0970-0323
Expiration Date: xx/xx/20xx

SAMPLING DECISIONS, ASSURANCES, AND FIELDWORK
PREPARATION PLAN
Part 1: Sampling Decisions
1a. Selection of cases and replacement cases
Lead Agency will select 276 cases and
replacement cases per month.
☐ Approval will be obtained from the ACF Regional Office before using any replacement cases
Clearly describe the Lead Agency procedure for collecting samples, including how replacement
cases are pulled separately.
1b. Random number generator
Name the source for the Lead Agency’s random number generator (the Random Number
Sampling Book or software)
1c. Frequency of collecting monthly sampling frames and projected start dates
Select the Lead Agency’s frequency of collecting monthly sampling frames
☐ Monthly ☐ Quarterly ☐ Semi-Annually ☐ Annually
☐ Other
Projected start date for the sampling process (Month/Year)
Projected start date for reviewing cases (Month/Year)
Comments on projected start dates (optional)
Note: The Lead Agency must receive OCC approval of the SDAP prior to drawing the first
sample, and OCC approval of the Record Review Worksheet prior to beginning case record
reviews, regardless of estimated projected start dates.
Part 2: Assurances and Certifications
The state assures that it will abide by the instructions contained in the Child Care Improper
Payments Data Collection Instructions.
1. The data collection process, including sample selection and case record reviews, adhered to
all requirements of the instructions and regulations for Error Rate Reporting at 45 CFR 98
Subpart K.
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2. The reviews were not conducted by persons who: (1) make or approve eligibility
determinations, (2) are under the supervision of persons responsible for eligibility
determinations, or (3) ever made or approved eligibility determinations for a case in which
they were assigned to review.
3. All reviewers have been trained to ensure that the review process is consistent with state
policies and that there is consistency within the state in interpretation of what is an error.
4. The state agrees to retain Record Review Worksheets, the State Improper Payments Report
and any revisions, and any other records pertinent to the case reviews and submission of error
rate reports for five years from the date of submission of the State Improper Payments Report
or final revision submitted, whichever date is later.
5. The state understands that this information, including the sampled case records and
calculations is subject to federal review.
6. Documents submitted to the Office of Child Care as part of the error rate review must not
contain any personally identifiable information (PII) as defined in Section I of the Child Care
Improper Payments Data Collection Instructions.
☐ Yes to all assurances
Part 3: Fieldwork Preparation Plan
3a. Identification of project leadership
Identify by name(s), job title(s), and role(s), the leadership of the improper payments process

☐ The leader(s) understands the program and has the authority to ensure timelines are met
Note: the level of authority should be comparable to that of the leader who is responsible for the
submission of the state plan.
Name and job title of the person who will certify and submit the final report:
Name and job title of the backup person who can certify/submit the report in their absence
[optional]
3b. Review team composition
Describe the review team by providing information about the following:
Size:
Composition:

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3c. Inter-reviewer consistency
Select and describe methods the Lead Agency will use to ensure inter-reviewer consistency.
Note: at a minimum, a re-review of cases must be selected and the description must include a
number or percentage of cases to be re-reviewed.
☐ Re-review of cases to ensure inter-reviewer consistency (required).
Describe, including the number or percentage of cases to be re-reviewed:
Improper payment error cases:
Nonpayment (administrative) error cases:
Cases with no error:
Describe:
☐ Group discussion of case review findings (optional). Describe:
☐ Other (optional). Describe:
3d. Error definition
For the purposes of the state improper payment review, define the following:
Errors:
Improper Payment errors:
Nonpayment (administrative) errors:
3e. Plan for review of state policies/procedures and processes
Describe the Lead Agency’s plan to ensure that customization of the RRW will use state policy
in effect during the sample month:
Describe the Lead Agency’s plan to ensure that reviewers consistently interpret error as defined
by the state:
3f. Pooling factor
Will the Lead Agency apply a pooling factor in the State Improper Payments Report? That is,
are funds from CCDF pooled with other funds for sampled cases?:
☐ Yes ☐ No

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Describe the process used to determine whether a pooling factor is applied, including the
individuals and entities involved. Note: if the Lead Agency does not use a pooling factor, they
should still provide information about how this was determined:
3g. Information systems project responsibilities
Select tasks that the Lead Agency accomplishes through coordination with information
technology staff:
☐ Identification of the universe of cases paid with CCDF funding
☐ Identification of the sample review calendar month payment amount
☐ Archival of the universe and sample frames files
☐ Use of random number generator software
☐ Generation of the 12 monthly sampling frames
☐ Selection of the monthly samples and replacement cases
☐ Determination of the annual amount of payments for the review period’s universe of children
☐ Other tasks, describe:
If these tasks are accomplished through some other means, specify which tasks and describe how
they are accomplished and by whom:
If using an automated or electronic Record Review Worksheet, describe its process for
development, including whether it will be developed in coordination with information
technology staff.
If using an automated or electronic Record Review Worksheet, provide an estimated timeframe
for information technology-related improvements and upgrades (e.g., 1 week, 2 weeks, 48
hours).
Describe the process used to determine the annual amount of payments:
3h. Case review logistics
Describe details of review logistics to include the following:
Whether electronic or physical records are reviewed. Describe:

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Whether record reading will take place on-site, off-site (excluding the Lead Agency’s office), or
both. Describe:
How the Lead Agency obtains and manages eligibility documentation, such as how reviewers
access and store images on a server, or how they request and receive documentation or images
from partner agencies responsible for determining eligibility. Describe:
The organization and maintenance of the review files. Describe:
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC
BURDEN: The purpose of this information collection is to gather data from states once every
three years about the errors occurring in the administration of CCDF grant funds. Public
reporting burden for this collection of information is estimated to average 106 hours per
response, including the time for reviewing instructions, gathering and maintaining the data
needed, and reviewing the collection of information. This is a mandatory collection of
information (45 CFR Part 98, Subpart K). An agency may not conduct or sponsor, and a person
is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number.
The OMB # is 0970-0323 and the expiration date is xx/xx/20xx. If you have any comments on
this collection of information, please contact ACF Office of Child Care.

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