Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in an appropriate digital format for editing.
2. Begin with Section I - Parent Information. Enter the name of the parent or legal guardian who has a child in the provider's care and the federal agency of the parent.
3. Move to Section II - Provider Information. Select the type of provider from the given options: Family Child Care, Child Care Center, or Federally Sponsored Child Care Center. Fill in the name, address, email address, and telephone number of the child care provider.
4. Continue with the tax identification number or Social Security Number of the provider, provider fax number, license number, license expiration date, and the state in which the license is issued.
5. In Section III - Child Information, provide the name and enrollment date of each child. Indicate if the child receives any other subsidy by selecting 'Yes' or 'No' and completing the additional fields if applicable.
6. If 'Yes' is selected for other subsidies, fill in the source of the subsidy and the amount of subsidy, along with the total weekly fee for the child.
7. Proceed to Section IV - Information on Provider's Financial Institution's Account for Payment to Provider. Enter the name of the financial institution, its routing number, and address. Specify the type of account—checking or savings—and provide the provider's account number.
8. Complete Section V - Signature of Provider. Enter the name of the provider, the title of the provider representative, and sign the form. Do not forget to include the date of signature.
9. After ensuring all information is accurate and complete, save changes to your document. You can then download, print, or share the completed form as needed.

Start completing your form online today for a smooth child care subsidy application process.