
For Office Use OnlyCHILD CARE ASSISTANCE PROGRAM REVIEW NORTH DAKOTA DEPARTMENT OF HUMAN SERVICESDate ReceivedClear FieldsSFN 841 (22021)Read review carefully and answer each question completely.
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How to fill out the ND SFN 841 online
This guide provides clear instructions on how to complete the ND SFN 841 form online. Follow the steps laid out in this document to ensure that you fill out each section correctly and completely.
Follow the steps to successfully complete the ND SFN 841 form.
- Click the ‘Get Form’ button to access the ND SFN 841 form and open it in the editor.
- Provide your personal information by filling out the first section. Include your first name, middle initial, last name, residential address, mailing address, and telephone numbers. Make sure to indicate your preferred language if you do not speak English.
- List all members of your household starting with yourself. For each person, include their name, social security number (optional), relationship to you, and date of birth.
- Answer questions regarding the parents in the home, including active military status and homelessness status.
- If applicable, provide details about any person temporarily out of the home and their expected return date.
- Indicate any recent household changes, including people who have moved in or out, with specific details about who and when.
- Complete the sections regarding school status, including listing adult members in school or training and their current status.
- Document your household's assets by providing the total estimated value.
- Fill out the earned income section. List last month's income for each employed person in your household, including employer details and expected income changes.
- Provide details about unearned income your household receives, ensuring to include documentation of any changes.
- Address any court-ordered spousal or child support, listing paid amounts and any changes.
- Complete the activities/programs section by indicating for which activities you need child care.
- Fill out the child care needs section, providing detailed activity schedules for children needing care, along with information about providers.
- Review and understand your rights and responsibilities. Sign and date where indicated.
- Once all sections are filled out, you can save changes, download the document, print it, or share it as needed.
Complete your ND SFN 841 form online today to ensure timely processing of your child care assistance.
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