Forms for Child Care Financial Assistance

Below are links to various forms required for use with The Child Development Division.  Child Care Financial Assistance helps eligible families with the cost of child care. Payments are made directly to child care providers.We use Adobe Acrobat PDF files as a means to electronically provide forms. You will need to have Adobe Reader software installed to access them (available FREE from Adobe's Website).  Simply click on the title of the form you wish to view/download.


Applications

Child Care Financial Assistance Application


Supplemental Forms (for parents)

CCFAP Child Support Information Form
Child Care Financial Assistance: CIS Family Support
Child Care Financial Assistance: CIS Child with Special Health Needs
Consent to Exchange Information
Employment Verification
Looking for Employment
School-Age Summer Schedule Form
School/Training Plan
Self-Employment Business Plan
Special Health Need (Adult)


Supplemental Forms (for Providers)

Direct Deposit Authorization Form
Provider Rate Agreement, Part 1 Financial Services
W-9 Form


Child Care Financial Assistance Eligibility Specialists Forms
(for CCFAP Eligibility Specialists ONLY)

Case Review Form Part I
Case Review Form Part II
CCFAP Case File Checklist Form
Consent to Exchange Information
Employment Verification
Financial Agreement, Part 1
Financial Assistance Regulations
Out of State Provider Request
PS-FC Request for Co-Payment
Records Pickup Request
Retroactive Payment Request
School Age Summer Schedule Form
Self Employment Eligibility Worksheets


Child Development Division

Deputy Commissioner Reeva Murphy
DCF - Child Development Division
280 State Drive
Waterbury, VT 05671-1040
Phone: (802) 241-3110 or 1-800-649-2642
Fax: (802) 241-0846

http://dcf.vermont.gov/cdd

Twitter    YouTube