| Form Number |
Current Revision
Date |
Title |
| DCD-0013 |
12000 |
Copy of Requirements for Payment of Care in the Child’s Home |
| DCD-0037 |
31996 |
Copy of Child’s Health/Emergency Information and Authorization Form for Transportation Providers |
| DCD-0038 |
92007 |
Copy of Requirements for Transportation Provider (Public and Private Agencies) |
| DCD-0039 |
92007 |
Copy of Requirements for Transportation Provider (Individual) |
| DCD-0040 |
102002 |
Copy of Forms Request |
| DCD-0047 |
52000 |
Copy of Sample Fingerprint Card |
| DCD-0048 |
52000 |
Copy of Authority for Release of Information |
| DCD-0049 |
52000 |
Copy of Notice of Child Care Provider Mandatory Criminal History Check |
| DCD-0050/0052 |
22002 |
Copy of Criminal Records Check Identifying Information Form for Regulated Programs and Nonlicensed Homes |
| DCD-0093 |
92007 |
Copy of Referral for Child Care - Children with Special Needs |
| DCD-0094 |
92007 |
Copy of Approval of Supplemental Rate |
| DCD-0106 (ENGLISH) |
82007 |
Copy of Recipient Responsibilities for Subsidized Child Care Services |
| DCD-0106 (SPANISH) |
82007 |
Copy of Recipient Responsibilities for Subsidized Child Care Services |
| DCD-0351 |
101998 |
Copy of Permission to Administer Medication |
| DCD-0376 |
12000 |
Copy of Health Questionnaire for Family Child Care Home Providers |
| DCD-0377 |
92007 |
Copy of Child's Health and Emergency Information for Family Child Care Homes |
| DCD-0404 |
92007 |
Copy of Application and Purchase Agreement for Child Care Transportation Services |
| DCD-0446 |
72009 |
Copy of Child Care Voucher and Instructions |
| DCD-0446-2 |
92009 |
Copy of Child Care Voucher Continuation Page |
| DCD-0450 |
92007 |
Copy of Child Care Action Notice and Instructions |
| DCD-0450-2 |
92007 |
Copy of Child Care Action Notice Continuation Page |
| DCD-0451 |
92007 |
Copy of Application for Enrollment to Be a Provider of Subsidized Child Care and Instructions |
| DCD-0452 * |
22005 |
Copy of Child Care Provider Agreement |
| DCD-0454A |
92007 |
Copy of Child with Special Needs Additional Expense Documentation |
| DCD-0454B |
92007 |
Copy of Provider Information Form |
| DCD-0455 |
42001 |
Copy of Nonlicensed Home Checklist |
| DCD-0456 |
12010 |
Copy of Application for Child Care Services and Instructions |
| DCD-0456 (SPANISH) |
102002 |
Copy of Application for Child Care Services and Instructions |
| DCD-0458 |
92007 |
Copy of Private Paying Rates and Other Fees and Instructions |
| DCD-0460 |
92002 |
Copy of Information About Subsidized Child Care |
| SAMPLE |
12000 |
Copy of Children’s Medical Report |
Subsidized Child Care Services Forms