Child Care Assistance Program
Please read through the list of forms below, to find the one that bests fits your needs as a parent or provider.If you have any questions about any of these forms, please contact us at 1-800-676-2805 and someone will be available to assist you.
Child Care Assistance Application – Complete this form if you are a new applicant or if your child care case has been cancelled for over 30 days. Please also download the Application Checklist to help ensure timely processing of your application.
Re-determination Form – Complete this form to redetermine your case once your approval period ends. Please also download the Re-determination Checklist to help ensure timely processing of your Re-determination form.
Change of Provider Form – Complete this form to change your child care provider or to add an additional provider to your current child care case.
Change of Information Form – Complete this form to report any change to your current child care case, including adding a family member, leave of absence, marriage or divorce, and a change of employment or income.
Wage Verification Form OR Letter of Employment Requirements Form (Either one of these forms are acceptable and may be submitted) - Your employer will need to complete this form if you have been employed less than 30 days and/or are unable to submit 2 current, consecutive and complete check stubs.
Self-Employment Records Form – If you have been self-employed less than one year and have not yet filed income taxes 3 full months of self employment records may be completed.
Child Care Rate Certification Form – This form is for providers who need to update their current child care rates.
Telephone Billing Agreement – After completing this form and submitting it to CCCC, providers receive a password in the mail, which allows providers to call in their billing certificates each month rather than mailing them to CCCC.
The following 2 forms are Change of Address Forms.
Attention Clients and Providers, please make sure you select the appropriate form.
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