Completing The EA 1

An application [EA1] is completed for each child who is experiencing an emergency. The date of application is the date the parent/relative, Mental Health professional, or Social Worker signs the EA application, not the date of removal/risk determination.

The EA 1 is designed to capture all information necessary to ensure eligibility to EA benefits and includes all of the following:

The initial EA application form
The Statement of Facts form for EA
The form on which the FC EW authorizes or denies EA benefits
The applicant's notification of approval or denial of EA assistance, including information about appeal rights.

The primary responsibility for obtaining the essential application information and signatures is with the social worker.

Instructions for completion are included on the back of the form. The EA1 is divided into three sections:

INFORMATION REQUIRED FOR ELIGIBILITY DETERMINATION (Completed by the Social Worker or Mental Health professional)
CERTIFICATION SECTION (Completed by the Social Worker or Mental Health professional)
ELIGIBILITY WORKER SECTION (Completed by the Intake FC EW)

Completion Requirements for the EA 1

The following clarifications are provided to assist the Intake FC EW in determining if the EA 1 is correctly completed.

Primary Box

All EA applications must be checked “Primary Application.” The “Supplemental Application” box is used when the SW provides additional information pertaining to the child episode. Currently, Santa Clara County (SCC) does not use the Supplemental Application.

Determination of Risk

The “Date Child Determined to be at Risk (Effective Date)” is defined as the date the child is determined to be at risk or removal by the SW or MH professional.

County Worker

Wherever the state uses the term “County Worker,” it refers to the Social Worker or Mental Health professional.

Relative

A list of persons who meet the definition of “relative” is in the Instructions on the back of the EA1. It is also included with Emergency Assistance (EA) Definitions.

Verification of the relative's relationship to the child is NOT required beyond his/her self-certification on the EA 1 form.

Signature/Certification Requirements

The reason why the parent is unable or unwilling to sign the EA 1 must be documented.

ExampleExample

A parent may have been contacted by phone and has agreed to sign the EA1 but was unavailable to do so. The Social Worker may sign it for him and document the reason. It is not necessary to obtain the parent's signature at a later time.

The name of the child's parent or relative must always be entered in the “Information Required for Eligibility Verification” section of the EA 1, even when the minor was living with a non-relative at the time of removal.

Identify the parent or adult relative from whom the child was removed or with whom the child has lived for the greatest amount of time during the prior six months.
A parent or relative other than the person with whom the child has been living within the last six months may sign the EA1 if he/she can provide the required information to complete the “Certification Section.” The information regarding the parent or relative with whom the child was living in the past six months must be entered in the “Information Required for Eligibility Verification'” section as the head of household.
If the other relative lacks the necessary information, then the Social Worker shall obtain it before signing the EA1 on behalf of the child.
Non-relative information must never be entered in the “Information Required for Eligibility Determination” section of the EA1.
Non-relative legal guardians do not qualify as relatives.