Amendment To An Application Child Care Center, School Age Only Center, Or Preschool printable pdf download

INSTRUCTIONS

Amendment to an Application

Child Care Center, School Age Only Center, Preschool

Please read instructions carefully BEFORE completing the Amendment to an Application.

Depending on the type of change, Fire and Sanitation inspections may need to be conducted.

Office of Children’s Services Licensing (OCSL) will NOT issue an amended license until ALL

required paperwork has been received, approved and, if necessary, inspections have been

completed and approved.

Completing the Application



Enter the complete name of the program as it appears on the license.



Enter the complete license number beginning with CCC, SAOC, or PRE.



Check the box __ in front of each of the item(s) which will be changed in sections A, B, and C and submit the required

additional information, completed forms, and documentation listed beside or below each item in the section.



Instructional information is written in Italics beside or below the required information, documentation or form to be

submitted.



FORMS are located on the Forms Page of the Nebraska Child Care Licensing Website found at the link below:



ALL required parties must sign the Amendment to Application. Signing this Amendment to Application verifies

that information provided is true and correct.

Section “C” Specific Instructions:



Change of Director: Documentation of Criminal History Record Check

If a criminal history is listed on the Report of Law Enforcement Contact Form, a Records Check document must be

obtained from a law enforcement agency, or agencies where cited, and submitted. This document must identify all

criminal history.

If no criminal history is listed on the Report of Law Enforcement Contact Form a Records Check form can be obtained

from the Nebraska State Patrol at: https://

If an individual has lived in Nebraska less than 12 months, documentation of a criminal history records check from the

previous state(s) of residence must be obtained and submitted.



Change of Director: Documentation of Director Qualifications.

OCSL must be notified within 2 working days of a change in director.

Review the regulations which govern the program and submit required documents accordingly. These are located on the

Child Care Licensing Website at:



For Child Care Centers see 391 NAC 3-006.04



For School Age Only Centers see 391 NAC 4-006.04



For Preschools see 391 NAC 5-006.04

For Child Care Centers ONLY: If you are submitting a written plan for obtaining the required education, information

and instructions can be found at:



Information-

https://



Instructions-

https://

Submitting the Amendment to an Application, documentation and forms:

OPTION 1: EMAIL: The completed application and the required additional documentation may be submitted to the Department by

scanning and emailing those documents to DHHS.ChildCareLicensing@nebraska.gov.

U.S. Mail

OPTION 2:

: The completed application and required additional documentation may be mailed to:

Cass, Douglas, Sarpy & Washington Counties:

ALL Other Nebraska Counties:

DHHS/Division of Public Health

Office of Children’s Services Licensing

1313 Farnam Street, 3

Floor

P.O. Box 94986

Omaha, NE 68102

Lincoln, NE 68509-4986

Amendment To An Application Child Care Center, School Age Only Center, Or Preschool

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