Get Dhs-5190-eng

The DHS-5190-ENG form is essential for registering as a licensed provider in the Minnesota Child Care Assistance Programs. This guide will walk you through the online process of completing this form efficiently and accurately.

Follow the steps to fill out the DHS-5190-ENG online effectively.

1. Click ‘Get Form’ button to obtain the form and access it in your preferred online editor.
2. Begin by entering the agency name, phone number, and address, including city, state, and ZIP code.
3. Select the type of facility or provider from the options: licensed family home or licensed child care center. Fill out the child care site name and total licensed capacity.
4. Provide details about the license holder, including their name, license number, and the issuing state or tribe.
5. Answer questions regarding your current and past authorization status with CCAP for any Minnesota county, marking 'yes' or 'no' as appropriate.
6. Enter the contact information for someone who can sign forms and answer questions for registration and billing.
7. Fill in your payment address if it differs from the site address, including the name and contact details for the person who can sign forms.
8. Document your standard rates for various age groups in the provider rates and policies section.
9. Review and attach your written payment policies, indicating any requirements for payment during absences or holidays.
10. Acknowledge your understanding of responsibilities and rights by checking each statement provided. Ensure you have read and understand the information.
11. Sign and date the form to finalize your application.
12. Once completed, save your changes, download the form, print it out, or share it as needed.

Complete your DHS-5190-ENG form online today for swift registration as a licensed provider.