Child Care Resource & Referral

Serving Southeastern Minnesota

Child Care Assistance Program forms

 

Do you need help paying for child care? DHS-3551               Brochure providing basic child care information and explaining the basic program requirements of the Child Care Assistance Programs. 
                     

Child Care Responsibilities and Rights  DHS-3990                         Child Care Assistance Programs (CCAP) information sheet explaining client's rights and responsibilities. 
             

Notice of Privacy Practices  DHS-3979                                          This notice describes how private information about you may be used and disclosed and how you can get this information.

Child Care Assistance Redetermination packet  DHS-5274                 **Please note: the Redetermination packet is for families that already have an open Child Care Assistance case.  It should not be used to apply for Child Care Assistance.

Change Report Form     DHS-4794                                                      Form used by Child Care Assistance Program clients to report income changes and other changes such as address, household members, jobs, etc.

Home Safety Checklist     Checklist that may be used by parents using an unlicensed child care provider to ensure the provider's home is a safe environment for children.

Child Care Assistance copays          DHS bulletin 09-68-05

Page under construction.  Please check back later for links to more forms.