Get Provider Change Form - River Valley Resources

The Provider Change Form for River Valley Resources is essential for updating care provider information under the Child Care and Development Fund Voucher Program. This guide will demonstrate the steps for successfully completing the form online, ensuring that all necessary details are provided accurately.

Follow the steps to complete the Provider Change Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the parent or guardian's name at the top of the form. This ensures that the correct individual is associated with the child care services. Proceed to provide the caregiver's name, business name (if applicable), and the street address where care will be provided.
3. Next, complete the city, zip code, and county fields. It is crucial to ensure this information is accurate to avoid delays in processing.
4. Enter the last four digits of the Social Security number or EIN number, along with a contact phone number and fax number if applicable.
5. Specify the type of provider by checking the appropriate box. This includes options such as licensed home, licensed center, registered ministry, and others. If applicable, provide the license or registration number.
6. Indicate the shift in which care will be provided and fill out the hours of operation. Circle the days of the week during which services will be offered.
7. Fill in the child's name and age in years and months. If the child is school-aged, include the school year beginning and ending dates. Indicate whether the school-age child needs break care vouchers by checking yes or no.
8. Affirm the information provided by signing in the designated area. This signifies that the information is true and that you agree to comply with the program's rules and regulations.
9. Finally, provide your email address and complete any additional fields regarding charges for care. After ensuring all sections are properly filled out, users can save changes, download, print, or share the completed form.

Complete your Provider Change Form online today to ensure uninterrupted child care services.