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CS-1067 Rev. 3/09 NEW YORK CITY CHILDREN S SERVICES DIVISION OF CHILD CARE and HEAD START Household Information for Child Care Recertification HOUSEHOLD INFORMATION FOR CHILD CARE RECERTIFICATION Please review the following information and indicate any changes on the lines provided. Please print legibly.

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How to fill out the Cs 1067 Form online

The Cs 1067 Form is essential for households seeking child care recertification in New York City. This guide will provide clear, step-by-step instructions to help you complete the form online accurately and efficiently.

Follow the steps to effectively complete the Cs 1067 Form online.

  1. Click the ‘Get Form’ button to access the form and open it in your document editor.
  2. Begin by providing your name and address details. Make sure to enter your name clearly, along with your street address, borough, city, and zip code.
  3. Enter your telephone number in the designated field.
  4. Indicate whether the provided information is correct by selecting 'Yes' or 'No'. If you have chosen 'No', print your new address and phone number in the spaces provided.
  5. Locate the case number section and fill in your case number accurately.
  6. Answer whether your household is a two-parent household by selecting 'Yes' or 'No'.
  7. In the household members section, provide the names of each household member. For each member listed, mark 'SAME' if they are current members or 'REMOVE' if they are no longer in your household.
  8. If there are new household members or children to add, include their last names, first names, and dates of birth in the designated fields.
  9. Remember to attach copies of birth certificates for any children being added.
  10. Finally, certify the information by providing your printed name, date, and signature. Ensure all information is accurate.
  11. Once you have completed filling out the form, you can save your changes, download the document, print it, or share it as needed.

Complete your Cs 1067 Form online for a smooth recertification process.

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