Follow the steps to effectively complete the form online.

1. Click the ‘Get Form’ button to access the MO 580-2039 form and launch it in the editor for completion.
2. Begin with the facility identifying information section. Fill in the legal name of the facility and the facility address, which includes the street address, city, state, and ZIP code.
3. In the certification section, confirm that you have included all staff and household members listed below. Ensure that the information you provide is true and accurate.
4. Enter the DVN (Departmental Vendor Number) assigned to your facility.
5. Complete the signature section by checking the appropriate title, followed by adding the date of completion.
6. For each child care staff member or adult household member, provide their identifying information. This includes their name, birth date, MOPD ID, position, and date employed.
7. Indicate their category by checking the relevant boxes for staff member or household member.
8. For household members under 18 years of age, complete the additional identifying information section by providing their name, birth date, and relationship to the provider.
9. Once all fields are filled out, you may save changes, download the completed form, print it for your records, or share it as needed.

Start completing your documents online today!