Form 2685 - Children'S Attendance Record Page 2
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2STATE OF NEW HAMPSHIRE
Form 2685
Department of Health and Human Services
February 2017
Division for Children, Youth and Families
***
:
NOTE
•
This is not an invoice
•
Original full signature or electronic signature of the parent/guardian is required for payment to be made
•
Actual arrival and departure time must include actual hours and minutes for each day
(note: please do not just write 8:00 am – 4:00
to receive your maximum authorized level of service for each child, it is important to indicate actual arrival and departure time,
pm).
which includes hours and minutes
(for example: 8:03 am – 4:27 pm)
•
If the parent/guardian does not sign the attendance record the provider:
cannot bill the division for children, youth and families for child care scholarship
O
may charge the parent/guardian for cost of services
O
•
When the child was scheduled to attend, and attended, you must indicate “P” for present on the attendance record
•
When the child was scheduled to attend, but was absent, you must indicate “A” for absent on the attendance record
•
When the child was scheduled to attend, but the program was closed, you must indicate “C” for closed on the attendance record
•
When the child was scheduled to attend, but the program was closed for professional development training, you must indicate “T”
for training on the attendance record
•
When the child was scheduled to attend, but the program was closed for a state determined holiday, you must indicate “H” for
holiday on the attendance record
•
When the child was scheduled to attend, but the program was closed for a state declared disaster, you must indicate “D” for
disaster on the attendance record
PD 17-17
February 2017
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P a g e
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