Get 10ad121e Child Care Form

Filling out the 10ad121e Child Care Form is a crucial step in ensuring proper submission of child care claims. This guide will provide you with clear steps to successfully complete the form online, ensuring all necessary information is accurately captured.

Follow the steps to complete the 10ad121e Child Care Form online.

1. Click the 'Get Form' button to download and access the 10ad121e Child Care Form in your preferred online editing tool.
2. In Part I, enter your provider information, including your name, contract number, address, phone number, and Social Security or Employer's ID number. Ensure all details are accurate to avoid processing issues.
3. Record the month and year of care provided in the designated section. This information is essential for processing your claim.
4. In Part II, check the appropriate box to indicate the reason for submitting a manual child care claim. Provide any necessary details if 'Client did not swipe attendance' is selected.
5. Sign and date the certification statement in Part II, ensuring that you verify the perjury notice and the correctness of the claim.
6. Proceed to Part IV, where you will detail each child's attendance record. Fill out the child’s name, date of care, times in and out for each day, and date of birth as required.
7. In Part IV, ensure all attendance records are filled out completely, certifying the information is accurate. Obtain the required signatures from the client, parent, guardian, or caretaker.
8. If necessary, complete the provider signature section at the end of Part IV, indicating your efforts to secure the client's signature.
9. Review all sections of the form for completeness and accuracy. Make any necessary edits before finalizing.
10. Once all information is correctly entered, save the changes, download or print the completed form, and prepare to share it with the applicable office.

Complete your 10ad121e Child Care Form online today to ensure your claims are processed promptly.