TrustLine (TL) Health & Safety - Completing the Forms

Completing the TrustLine Referral (SCD 511)

The TrustLine Referral (SCD 511) is the form used to refer a child care provider who is NOT exempt from TL to the Santa Clara County Office of Education (SCCOE). The Associate Employment Counselor (AEC)/Employment Counselor (EC) completes the top half of the SCD 511, and the SCCOE completes the bottom section.

Enter today’s date.
Enter the address of the CalWORKs Employment Services (CWES) office.
Enter the AEC/EC number.
Check the type of program: CalWORKsCalWORKs
Check the “No” box if the child care provider has not been TL'd and has no pending application.
Enter the child care provider’s name and address.
Enter the child care provider’s identification (ID) number. The ID must be valid and can only be:
1. A driver’s license number
2. A California ID number, issued by the Department of Motor Vehicles (DMV)
3. A permanent resident number, or
4. An out of state numbered photo ID card.
Enter the client’s case number in the space titled “ID Case #”
Print your name in the certification area. You are certifying that the customer is eligible for child care.
Sign and date the certification. Enter your work phone number.
Give the provider the SCD 511. When the provider completes the TL registration process, the SCCOE will complete the bottom of the SCD 511 and email a copy to the designated staff person at Senter Road.
The CWES designee at Senter Road will forward the copy to Imaging and forward an email to the assigned AEC/EC.

“TrustLine Registry Application” (TLR 9163G) Sections

The TrustLine Registry Application (TLR 9163G) has two sections (#6 and #13) that the AEC/EC must ensure are completed. These sections must be completed before the packet is given to the client.

Section	Action
Section 6: Agency Information
Program (subsidized programs only)	Mark the appropriate program
Case No.	Enter the appropriate information
Section 13: Resources & Referral/Payment Program
Program	Mark the appropriate program
Case No.	Enter the appropriate information

Note: Ensure that the TLR 9163G fields/boxes are pre-populated with the appropriate information.

“TrustLine Registry Application” (TLR 9163G) Completed

The client is responsible for ensuring that the provider completes two copies of the TLR 9163G. One copy goes to the Live Scan operator to electronically transmit the applicant's informational data and is kept for their records. After the prints are rolled, the provider must scan or take pictures of the application (SCD 511 and the second copy of the TLR 9163G) and email them to the SCCOE at trustlinescc@sccoe.org.

“Checklist for TrustLine and Health and Safety Self-Certification” (SCD 533)

The AEC/EC is responsible for completing the Checklist for TrustLine and Health and Safety Self-Certification (SCD 533) and forwarding the form to Imaging. The purpose of the checklist is to help the AEC/EC avoid missing any critical steps in the TL registration process.

“Important Notice - Child Care TrustLine Registry System” (SCD 514)

This notice is included with the packet and is used as a cover letter and overview of the TL process. The form includes Live Scan locations in Santa Clara County, along with a web-link that provides additional information. Refer to Live Scan Locations.

“Health & Safety Checklist” (SCD 1178)

This checklist provides parents with a list of suggested questions to ask their child care provider to ensure that the home where the care is to be provided is a safe and healthy place for their child(ren). There is no legal requirement for the provider to meet the health and safety items on this form. This form is not to be returned to the AEC/EC.

“TrustLine Informing Notice” (SCD 209)

The TrustLine Informing Notice (SCD 209) is a required form and is used to inform a client who indicates that they are considering using a license-exempt child care provider about the TL requirements. The form must be signed by the client and the child care provider.

“Health & Safety Self-Certification” (CCP 4)

The Health and Safety Self-Certification (CCP 4) must be included with the TL packet. This is a mandatory form to be completed by the client and child care provider, indicating that health and safety requirements have been met. The CCP 4 must be signed by both the parent and the child care provider and MUST be returned to the AEC/EC within seven calendar days from the date the TL packet is issued. This form must be on file BEFORE child care can be paid.

Note: This form is not sent to TL and is ONLY forwarded to Imaging.

“Notification of Parental Choice with TrustLine Registration” (SCD 180)

The Notification of Parental Choice with TrustLine Registration (SCD 180) must be mailed/issued to the client at 30, 60, and 90-day intervals. This form notifies the client when 30, 60, or 90 days of the 120-day retroactive payment period has elapsed. It also reminds the parent of the option to choose another provider in case the provider of choice does NOT become TL registered.