This new RJOA form must be used when submitting attendance for School Readiness children that have absences due to extraordinary circumstances beyond 3 for the reimbursement calendar month. Please use
only this form as all other versions of the form are invalid and cannot be used to reimburse for extraordinary absences after July 31, 2017.
Below are Step by Step Instructions for School Readiness Providers so that the RJOA forms can be processed properly:
The RJOA form must be submitted by the same deadline as the attendance (see 17-18 SR Agreement for details). Late RJOA forms and supporting documentation will not be processed with the current month.
Please complete the entire top section of the form with your provider name, your FEIN/SSN, child's full name per ELC eligibility documents, last 4 numbers of child's SSN and the billing group that the child is funded through. Incomplete forms may be denied.
Please enter the month and the day (ex: 7/11) in the date box when the child has more than 3 absences in the reimbursement month, and when the reason for the absence meets one of the 5 allowable reasons that extraordinary absences can be reimbursed. The extraordinary absences can only be for one of the five (5) reasons listed under the Reimbursement Code section of the RJOA form. Please read each code, 1 through 5, carefully and be sure to submit supporting documentation as required per the code with the RJOA form. Absences due to vacation, recreational time or transportation issues are not reimbursable.
The provider AND parent/guardian must sign and date the form. The date of the signatures must be later than the last date of absence recorded on the form for the child, or the form cannot be processed. No documentation is needed for an illness in which the child does not need to see a doctor; however, if the child does see a doctor, it is highly recommended that a doctor's note be submitted with the RJOA form. Please use a code 2 for this reason.
In order for extraordinary absences beyond 3 to be considered for reimbursement, this completed form and the required supporting documentation for the absences must be uploaded to the REIMB_SR-Excessive Absence Forms and Documents folder in your Document Library of your Provider Portal. Please do not fax form with documents.
During processing, the Reimbursement Specialist will write a response with the status of the form in the description field for each child's form that is uploaded into the provider's Document Library.
Responses are as follows:
Processed: a properly completed form in which the absences and documents were eligible for reimbursement.
Denied: something is wrong with the form or the supporting documentation. There will be more information added to the description for each child to advise the provider why the form cannot be processed as is or if there is a reason why absences are ineligible for reimbursement.
Late RJOA forms and supporting documentation will be processed with the next reimbursement period. The status will be marked as
printed,as absences can only be reimbursed via an adjustment after the current reimbursement period is closed.
Please use these instructions to help you complete the RJOA form properly and to help you understand this process.
You may Download the form by clicking here
If you need further assistance, please contact your School Readiness Reimbursement Specialist using the caseload assignment list below. Thank you.
Phone Nu
mb
er and email for SR Reimbursement Specialists
