Professional Type B Child Care Licensing First Contact Packet printable pdf download

Professional Type B Child Care Licensing

First Contact Packet

Thank you for your interest in our program. Please complete and return all items listed below – incomplete applications will

100

not be processed and will close after 90 days. Intake staff will approve or deny completed applications within

days

from the date we receive the completed application. Child Care forms are available at

More detailed instructions for completing the forms listed below can be found on pages 2 – 3 of this document.

Form #

Title

What you need to do

Copies to print

JFS 01643

Application for Licensed Type B Home

Complete all 4 pages

• Print & sign 1 copy

JFS 01923

Emergency/Substitute Caregiver Statement for Type

• Emergency/Substitute Caregiver completes top

• Print & sign 1 copy

B Home Provider

portion of the form

• Provider completes bottom

JFS 01329

Statement of Nonconviction for Type B Homes and

Completion of page 1 by:

• Print & sign as many

In-Home Aides

• Type B Home Provider

copies as appropriate

• Adult Household Member

• Emergency/Substitute Caregiver

HCJFS 0170

Authorization to Release Information to Hamilton

Completion by:

• Print & sign as many

County

• Type B Home Provider

copies as appropriate

• Adult Household Member

• Emergency/Substitute Caregiver

JFS 01302

Request for Child Abuse and Neglect Report

Completion by:

• Print & sign 1 copy

Information

• Type B Home Provider

• Emergency/Substitute Caregiver

• All household members

HCJFS 3026

Not necessary to print

Just the Facts….About the BCI&I and FBI Criminal

• Read

Records Searches and Webchecks

• The following must submit to Local, BCI&I, &

FBI background checks:

 Type B Home Provider,

 Emergency/ Substitute Caregiver, and

 Any adult household member

• Return results of Local background check

• Return receipt showing payment for Local,

BCI&I, & FBI background checks

• The Reason code for the request MUST BE

ORC 5104.013

JFS 01280

Medical Statement for Type B Home and In-Home

Physician completes

• Print & sign 1 copy

Aide Child Care Providers

JFS 01332-I

Not necessary to print

Instructions for Completing JFS 01332, Certified

Read the instructions

Child Care Handbook for Caretakers

JFS 01332

Child Care Handbook for Caretakers Licensed Type

Complete the form as outlined in the instructions

• Print

B Home Providers and Certified In-Home Aides

above

Additional items you need to return to us

• Copy of applicant’s high school diploma or GED certificate and copy of applicant’s Social Security card

• Copy of driver’s license and insurance card for provider and emergency/substitute care giver.

• Children residing in the home under the age of 6 are required to have a of a medical examination per 5101:2-14-15 (B)

Additional requirement for the Provider and Emergency/Substitute

• In service training form for CPR, First Aid and 8-hour Health and Safety Training

Additional requirement for children aged 12-17 residing in the home

HCJFS 0472-A

Juvenile Court Information Release form

• This background check is required for all

• Obtain form from

children 12-17 residing in the home.

HCJFS

• Return results of Juvenile background check

Child Care Intake

Please complete and submit

floor

the forms above and the

222 E. Central Parkway

additional items listed to:

Cincinnati OH 45202

HCJFS 8058-A (REV. 10-14)

Page 1 of 3

Professional Type B Child Care Licensing First Contact Packet

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