Follow the steps to complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the child care worker. This should be the individual who will handle the withdrawal process.
3. Next, provide the name of the center where the child is enrolled. This information helps in identifying which facility is processing the withdrawal.
4. Fill in the provider number associated with your childcare center. This number is crucial for administrative purposes.
5. Enter the parent's name clearly. Ensure the name matches the official documents to avoid any processing issues.
6. If there is no case number, include the parent's Social Security Number (SSN). This is necessary for identification in the system.
7. List the names of the children being withdrawn from the program. Make sure to spell each name correctly.
8. Provide the last day of attendance in the format of Month/Date/Year. This date is important for record-keeping purposes.
9. Detail any delinquent co-payment information. Include the month/year and amount owed for each child, as this is vital for financial records.
10. If there is a known reason for withdrawal, provide that information in the specified section.
11. Obtain the center's signature and date to verify the withdrawal information.
12. Finally, the parent must sign and date the form to confirm the withdrawal.
13. After ensuring all fields are completed accurately, save your changes. You can then download, print, or share the completed form as needed.

Start completing the OH CCU-91 - Lorain County form online today to ensure prompt processing.