Follow the steps to successfully complete your provider information page.

1. Click ‘Get Form’ button to access the form and open it in your preferred format.
2. Begin by entering the parent or guardian's name in the designated area at the top of the form. This section requires the full name for identification purposes.
3. Next, provide the caregiver’s name. Ensure this is the individual who will be responsible for child care.
4. Fill in the date the form is completed by selecting the appropriate date.
5. Input the business name, if applicable. If no business name is used, leave this section blank.
6. Enter the street address where care is provided, followed by the city, zip code, and county.
7. Complete the section for the Social Security or EIN number by entering the last four digits only to maintain confidentiality.
8. Provide the phone number and fax number for contact purposes. Ensure the area codes are included.
9. Indicate the type of provider by marking the appropriate checkbox for licensed home, licensed center, registered ministry, license exempt home, license exempt facility, or care provided in the child’s home.
10. List your license number(s) as required. Include the relevant registration number if applicable.
11. Indicate hours of operation and mark which days you operate by circling the appropriate days of the week.
12. Fill in the child's name and age in years and months. Indicate kindergarten attendance by checking HD for half-day or FD for full-day as applicable.
13. Enter your current charges for school-age programs by listing them in weeks, days, or hours as applicable.
14. Specify the charges for the next age group if applicable, detailing charges for summer or evening care separately.
15. Provide your current Paths to QUALITY™ level, ensuring you have included all necessary documentation.
16. Fill in the school year start and end dates. Answer the question regarding break care vouchers as applicable.
17. In the provider affirmation section, read and understand the compliance statements, then provide your signature and the date.
18. Lastly, if you have any familial relation to the children listed, provide an explanation. Ensure all fields are completed accurately.
19. Once all information has been entered and verified, you can save changes to the document, download it for your records, print it out, or share it with relevant parties.

Complete your IN Child Care And Development Fund Provider Information Page online today for timely processing.