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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.

E-mail Agreement – To receive e-mail notices of case updates-parents and providers must sign-up for these updates. You may sign-up for e-mail notification by completing this form.

If you are needing a Redetermination, Change of Provider, Add/Delete Family Member or Wage Verification form, please contact Community Child Care Connection, Inc. to request the necessary form.

Letter of Employment Requirements Form – 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.

Client Change of Address Form

Provider Change of Address Form

 

 

 

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