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New Jersey Department of Children and Families Policy Manual




Child Protection and Permanency

Effective Date:













CP&P Form 16-34, Check Receipt



Click here to view, complete or print CP&P Form 16-34, Check Receipt.




The Check Receipt is used to provide written documentation of checks issued by CP&P, including:


·                     The origin of the check - LOBA Fund, Flex Fund, etc.


·                     The Check Payee or Client.


·                     Who received the check, and the date he or she received it.


·                     The express purpose for which the money is to be used.


·                     The check number and the amount issued.


·                     Who released the check.


In addition, the form provides an audit trail to track the distribution of the check.


See CP&P-IX-F-1-300, Local Office Bank Account (LOBA).




The form is prepared by the Local Office Bank Account Clerk (Custodian) whenever a check is issued from the LOBA Fund or the Flex Fund. The Clerk completes the form by using the on-line template. See section below entitled “Signatures.”


When delivering a check, the employee reiterates:


·         The person in receipt of the check shall not make a purchase in excess of the authorized amount of the check, unless he or she is prepared to pay the balance due, in full, to the merchant;


·         The person in receipt of the check agrees to return any portion of the check that is not used for the express purpose of the payment (in excess of one dollar - $1.00). Refunds are to be made by check or money order (not cash), payable to the Treasurer, State of New Jersey; and


·         The Payee, or other person in receipt of the check, is prohibited from using the bank routing information on the bottom of the check to make electronic payments or purchases over the telephone or via the internet.


If the check is being mailed, write a cover letter, instructing the Payee to sign the Check Receipt. (Indicate in the letter where the Payee is to sign, print his or her name, and enter the date when the check was received.)  Provide a self-addressed, stamped envelope to facilitate return of the signed form.


Whenever a check is made out in the name of a CP&P employee, the Payee (i.e., the CP&P employee) must sign a Check Receipt (as both "Check Received By" and as "Check Payee"), and return it, along with a merchandise receipt, to the LOBA Custodian for purchases made or services received. Any unused funds over one dollar ($1.00) must be refunded.


If a copy of the Check Receipt is being provided to a vendor, determine whether to redact (i.e., remove or black out) confidential information from it. Consult the Supervisor or Litigation Unit/Para Legal for guidance, if needed.




Enter the name of the "participant" - a specific child, the parent or client, or the subject of the check - in the space provided.


Enter New Jersey SPIRIT identification numbers, where indicated, including the NJS Case Identification Number, the participant Identification number, and  the NJS resource Identification number, if applicable.


Check a box, to indicate the funding source (LOBA Fund, Flex Fund, or "other" source). If "other," name the funding source in the space provided.


Obtain signatures and dates when releasing a check to the Worker, Payee, or Client. A "to" and a "from" signature is required each time the check changes hands. Print the person's name, to accompany each signature, for clarity and proper documentation.


Check the box at the bottom of the form - by "Attached" - when attaching a merchandise receipt, an invoice, or another document to the Check Receipt.




The following persons sign the Check Receipt:


·         Check Payee or Client - the person taking possession of the check from the "Received By" person signs his or her name, and dates the form to confirm receipt of the check.


·         If the Check Payee is not the client - e.g., Wal-Mart - the LOBA Custodian inserts "Wal-Mart" on the Check Payee line before releasing the check.


·         Check Received By - the person accepting the check from the LOBA Custodian signs his or her name and enters the date to acknowledge receipt of the check.


·         If the "Received By" is the last signature, this person is responsible to ensure that the purchase and/or service obtained, was in accordance with the express purpose of the check.


·         Check Released By - the employee who releases the check - usually the LOBA Custodian - prints his or her name and signs and dates the Check Receipt to confirm that the check was released/delivered.






Local Office fiscal records file - the "LOBA File" - maintained by the Local Office Bank Account Clerk (Custodian). Keep a copy of the initial release. Obtain and retain the original, once all parties sign and date it in the spaces provided.




Each person who signs the form should retain a copy for their files.


Copy (optional)


Case record