Qualified clinics receiving a payment for employees must attest that the payment was made within 60 days of receiving funds to approved eligible employees. The post-payment report must be submitted to the Department of Health Care Services (DHCS) within 90 days from receipt of funds, using the attestation link provided to the entity’s designated contact via email message sent from CWSRP@dhcs.ca.gov.​​ 

提交付後分配報告​​ 

An attestation link will be sent to the entity’s designated contact along with the Payment Detail Report via email from CWSRP@dhcs.ca.gov after the payment has been issued. The following information is required to be collected as a part of the post-payment report/attestation:​​ 

• 分配給合資格僱員的資金總額​​ 

• 向您的員工發出上次付款的日期​​ 
  

• 退回給 DHCS 的不可交付/超額資金金額（如適用）​​ 

• 超額金額退還給 DHCS 的日期（如適用）​​ 

• 證明人姓名及職稱​​  

為了完成報告，我們會要求您在組織內輸入您的名字和姓氏以及您的職稱，以確認並證明您輸入的信息是真實、準確和完整的。​​ 

證明聲明：​​ 

我根據加利福尼亞州的法律，在偽證罰下聲明，從衛生護理服務部（DHCS）收到的分配金額已向合資格僱員發放。 根據我所知，我提供的所有信息都是真實、準確和完整的。 此外，我已將超額金額和所需的詳細信息發送到退還支票指南部分中提到的地址。​​ 

我獲授權代表實體提交此信息。 我明白，在下方框中輸入名字和姓氏即代表我的電子簽名。​​