How to Fill Out the CalWORKs Child Care Reimbursement Report (CCP 2145)

To fill out CCP 2145, the CalWORKs Child Care Reimbursement Report, the parent completes Part A with case and child information and a signed certification, the child care provider completes Part B with the monthly billing summary, and both parties sign on or after the last day of care for the month. One form is submitted for each child, every month, to your county welfare department’s child care worker.¹

Most payment problems trace back to something small on the form itself: a missing signature, a date written too early, a provider name that doesn’t match county records. Working through each part carefully the first time is faster than fixing a rejection later.

Part A: The Parent Section

Part A collects who you are, who the child is, and your sworn statement that the information is accurate.

Enter the primary parent’s name, your CalWORKs case number, phone number, and mailing address. If a second parent lives in the household, add their name and phone number. Then enter the child’s full name, date of birth, and age. Each child needs a separate CCP 2145; you cannot list siblings on the same form.¹

The form asks whether your child care provider has changed since your last payment request. If the provider filling in Part B is not the one currently authorized by your county, stop and call your child care worker before submitting. A new provider must be approved first; a form listing an unapproved provider will not be paid.¹

Part A also asks you to report whether your family income has reached or exceeded the thresholds printed on the form. Those thresholds vary by family size. If your income has crossed one since you last reported, mark it here.

The section closes with a certification you sign under penalty of perjury. By signing, you confirm that you chose the provider, that you understand the provider must be licensed or qualify as license-exempt, that you may be treated as the employer if care takes place in your own home, and that you will repay any child care benefits you were not entitled to receive.¹ Do not sign or date this section before the last day of care for the month; an early signature invalidates the form.

Part B: The Provider Section

Part B is the provider’s billing summary. The provider fills it in, not the parent. It functions as the invoice the county pays against.

The provider enters their name and facility information, along with their Social Security number or tax identification number. On older versions of the form the SSN/tax ID field is marked optional, but it may be required for payment processing.

Below the identifiers, the billing summary breaks charges into rate categories. The provider fills only the categories that match how they bill:

Monthly rate — a flat rate for the full month.
Weekly rate, multiplied by the number of weeks of care.
Daily rate, multiplied by the number of days of care.
Hourly rate, multiplied by the number of hours of care.
Evening rate, for care during evening hours.
Weekend rate, for care on weekends.
Other fees, for any additional charges.
Total billed for the month.

A licensed center that charges a flat monthly rate completes only that single line. A license-exempt provider paid by the hour completes the hourly rate and the total hours instead.¹ Reimbursement is subject to state rate ceilings, so if the provider’s rate is above the applicable cap, the county will pay the cap rather than the billed amount.

The provider then signs and dates Part B. As with Part A, the signature must be on or after the last day of care for the month.

The Attendance Sheet on Page 3

Page 3 is a Time-In and Time-Out Sheet. It is not required for every family. The form specifies that it is used only when the child is enrolled in school or is on a split schedule, meaning the child goes to care, then to school, then back to care in the same day.¹

When it applies, the provider records, for each day care was given: day of the month, day of the week, time in, time out, provider initials, total hours for that day, and the reason for any absence. At the bottom of the sheet, the provider adds up total hours of care for the month. The county uses this to confirm that reimbursement matches actual hours delivered in situations where a flat daily or weekly rate would not.

Signatures and Timing

Both signatures on CCP 2145 must be dated on or after the last day of care for the month being billed. A form signed mid-month is incomplete and will be rejected. This is the single easiest error to make and the single easiest to prevent: wait until the month is over, then sign together with the provider if possible.

Where and When to Submit

Send or deliver the completed CCP 2145 to your assigned child care worker at your county welfare department each month.¹ The mailing address or drop-off location depends on your county, so confirm with your worker if you are unsure. Some counties require the completed form by the 5th of the following month, though the deadline can vary.

The form itself warns that if a complete report is not received each month, child care benefits may be late, denied, or stopped.² Submitting on time, with both signatures and every required field completed, is what keeps payments moving.

Common Errors That Delay Payment

Most delays come from a short list of preventable mistakes:

Missing signatures, or signatures dated before the last day of care.
A provider listed in Part B who has not been approved by the county because the parent switched without notifying the child care worker first.
An incomplete billing summary in Part B — at minimum, at least one rate category and the total billed must be filled in.
A license-exempt provider (other than a grandparent, aunt, or uncle) who has not yet completed TrustLine registration.³
Failure to report household income that has reached or exceeded the thresholds on the form, which can lead to an overpayment you have to pay back.

The form warns that providing wrong or incomplete information can result in legal prosecution, fines, or imprisonment.² Honest mistakes are handled administratively; deliberately falsifying hours or provider details is treated as fraud.

When Payment Should Arrive

Once the county or its contractor has a complete CCP 2145, the provider should be paid within 21 calendar days.⁴ That clock starts only when the form is complete. Missing signatures, blank fields, or unfinished TrustLine registration reset it. In counties that run Stage One in-house rather than through an Alternative Payment Program, a separate state-level payment process applies, and turnaround can run up to 25 calendar days after the state processes the payment file.

Where to Get a Blank Form

Your county welfare department usually provides pre-printed CCP 2145 forms with your case number and authorized provider already filled in. If you need a blank copy, the California Department of Social Services publishes the form on its website.² The current version at this writing is CCP 2145 (7/23). If you have an older copy on hand, ask your child care worker whether it will still be accepted before you use it.

If You Are Actually Looking for an Unemployment Appeal Form

CCP 2145 has nothing to do with unemployment insurance. If you received a Notice of Determination from the Employment Development Department and want to appeal it, the form you need is DE 1000M, which must be filed within 30 days of the mailing date on the notice and sent to the EDD office listed on that notice.⁵⁶

1
Fresno County. CalWORKs Child Care Reimbursement Report (CCP 2145)
2
California Department of Social Services. CalWORKs Child Care Reimbursement Report
3
California Department of Social Services. TrustLine License-Exempt Provider Pamphlet
4
California Department of Social Services. SB 140 Child Care Provider Payments
5
Employment Development Department. Appeal Form (DE 1000M)
6
California Legislative Information. California Code, Unemployment Insurance Code – UIC 1328