Get Child Care Subsidy Referral Form 2020-2025

Filling out the Child Care Subsidy Referral Form online is an important step in securing child care assistance. This guide provides a detailed walkthrough of the form's components, ensuring you complete it accurately and efficiently.

Follow the steps to successfully complete the Child Care Subsidy Referral Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'Date' field, enter the current date when you are completing the form.
3. Fill in the 'Health Care Provider or Caregiver' section by stating your name, followed by the 'Type of Referral' that applies to your situation.
4. Complete the 'Applicant Information' fields, which include the parent’s name, spouse's name if applicable, date of birth, race, and social security number (optional). Ensure you provide the information accurately.
5. In the 'Employer Information' section, provide your employer's name, address, and phone number.
6. Fill out the 'Residential Address' section with your residential address details, including city, county, state, and zip code. Don't forget to include your email address for further communication.
7. In the 'Children Needing Care' section, list the names, dates of birth, race, and sex of each child. Indicate whether the parental fee is waived by marking 'Yes' or 'No'.
8. Select the appropriate amount of care needed (full-time or part-time) and input the dates when care needs to start and end.
9. Provide the name and address of the licensed child care provider you plan to use.
10. Add any additional information that may be necessary in the provided section.
11. Confirm the accuracy of your information by signing in the designated area as the applicant. The employer’s authorized designee must also provide their signature.
12. Once all fields are completed and reviewed, save your changes. You can download, print, or share the completed form as needed.

Complete the Child Care Subsidy Referral Form online today and take the first step towards securing child care assistance.