Dfps Form J-800-2838 - Request For Exemption From Regulation

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J-800-2838
New June 2014
M
E
ISCELLANEOUS
NTITIES
R
E
F
R
U
40 TAC
EQUEST FOR
XEMPTION
ROM
EGULATION
NDER
§745.129
Child Care Licensing (CCL)
Purpose: Licensing uses this form to determine whether your program is exempt from DFPS regulation based on an
exemption for one of the following:
A neighborhood recreation program: 40 TAC §745.129(1)
•
A caregiver who has written agreement with a parent to provide residential care: 40 TAC §745.129(3)
•
An emergency shelter for minors: 40 TAC §745.129(4)
•
A child or sibling group placed by DFPS: 40 TAC §745.129(5)
•
A food distribution program: 40 TAC §745.129(6)
•
An emergency shelter for victims of human trafficking: 40 TAC §745.129(7)
•
Instructions: Complete all sections of the form that are relevant to your type of program. If a question does not
apply, enter Not Applicable in the space.
For further clarification, review 40 TAC Chapter 745 (Licensing), Subchapter C, Operations That Are Exempt From
Regulation at:
Directions: If you have questions when completing the form, contact your local Licensing office. Please mail the
completed form and any other application-related materials to your nearest Licensing office. Information on local
Licensing offices can be found at:
SECTION A - IDENTIFYING INFORMATION
Program Name
Program Website
Address
City
Zip Code
Mailing Address (if different)
City
Zip Code
Name of Owner, Partners, Governing Body, or Sponsoring
Is the governing body nonprofit?
Organization
Yes
No
Your Name
Your Phone Number
Your Email Address
Your Address (Street Address, City, State, Zip Code)
SECTION B - PROGRAM INFORMATION
Please answer the following questions about your overall program:
What is the overall purpose of your program?
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