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Get OR DHS 7494 2019

Oregon.gov/dhs/assistance/CHILD-CARE/pages/index. aspx. The Child Care Provider Guide DHS 7492 is on this website for your convenience. Oregon.gov/OCC/Pages/forproviders. aspx. Q. Besides filling out the Child Care Provider Listing form is there anything else I need to do to start the process to become listed and approved with DHS A. The family may also be responsible to pay for some of the care. If there is more than one provider for a child each provider will be assigned a percentage of the hours for each month. If you are exempt from licensing by the Office of Child Care OCC you are required to take the DHS Orientation class within 90 days after you are approved. More information will be sent to you. For more information regarding child care go to DHS child care information website www. oregon.gov/dhs/assistance/CHILD-CARE/pages/index. Oregon.gov/dhs/assistance/CHILD-CARE/pages/index. aspx. DHS conducts background checks for child care providers exempt from licensing by the Office of Child Care OCC. This includes Criminal and child protective service records checks and is required for the provider any member of the household who is age 16 or older and any visitors to the home who may have unsupervised access to a child in care the site director and each employee who may have unsupervised access to a child in care. Instructions to provider Keep this page for your records. 1. Please answer completely and sign the attached Child Care Provider Listing form. Use black or blue ink and print clearly 2. Providers who are required to take the Health and Safety Training must take the training prior to submitting this listing form. See question 16A on the listing form for additional information. Go to the website www. oregon.gov/dhs/assistance/CHILD-CARE/Pages/training. aspx to complete this online training. This training is in addition to any other trainings that you may have taken. 3. You will be eligible for payment for an eligible child for care provided on or after the date your listing is approved by DHS. DHS will not pay for any care provided before the listing approval date as well as any care if you are not approved. Providers are required to meet all DHS standards and provider requirements in order to qualify for payment from DHS. For full standards and requirements see the Child Care Provider Guide DHS 7492 or visit www. oregon.gov/dhs/assistance/CHILD-CARE/pages/index. aspx. DHS conducts background checks for child care providers exempt from licensing by the Office of Child Care OCC. If you are a Registered Family Provider RFM or not required to be licensed with OCC you are required to take either the online Basic Child Care Health and Safety BCCHS training or the three hour Oregon Kids Healthy and Safe OKHS classroom training prior to submitting this Provider Listing form. This training is called Basic Child Care Health and Safety BCCHS is located online at I have completed the online Basic Child Care Health and Safety BCCHS training. sent to DHS. OR training. If you marked yes please attach your certificate. OR You may not need to take the Basic Child Care Health and Safety training if you meet one of the exemptions below Is English your preferred language If you marked No you are exempt at this time Do you have internet access available If you marked No you are exempt at this time 16. Name last first M. I. Other names used Driver license number or ID number/state Authorizing signature Sex c Male c Female Have you lived outside Oregon for 60 days or more in the past 18 months c Yes list state s c No Have you ever had criminal arrests conviction s If any of the boxes are checked yes please attach a separate sheet of letter-sized paper explaining all past and current history. Include each incident date and location. Household members age 16 and older all other employee/volunteers and visitors see information sheet complete this section. Each person who is required to have a background check will need to answer the questions and sign. If you need more space attach additional sheets of paper to this form. c Male c Female I am a check one c Household member c Visitor c Employee/volunteer continued 20. PROVIDER AGREEMENT Please read and sign below. All child care providers are required to See the DHS Child Care Provider Guide DHS 7492 for complete information or check our website at https //apps.

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