Military Fee Assistance Child Care Provider Agreement Form

Military Fee Assistance Child Care Provider Agreement Form

Submit to:

or fax to 571-255-4911

I [the Provider/Program] with assigned Provider ID Number P#________________ understand/agree that (please check all boxes):

The rates listed in this application and/or attached are the true and correct rate that I charge to ALL parents for the care of their child(ren).

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Provider/Program understands that they cannot charge military families a different or higher rate than private pay clients because they are receiving fee assistance.)

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Provider/Program understand that if approved for the program, Child Care Aware® of America Fee Assistance Program and the parent co-pay will equal the provider’s

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current rate

Provider/Program understands that child care rates for the entire calendar year for all age groups served need to be submitted in order to be approved

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Provider/program understands that all discounts, additional subsidies, waivers, grants, etc. must be declared up front when reporting the Military sponsor’s rates.

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Incorrectly reporting rates or suspicion of incorrectly reporting rates may result in immediate termination from ALL of Child Care Aware® of America’s Military Fee

Assistance programs.

Child Care Aware® of America reserves the right to deny approval of any and all child care providers that submit applications for Child Care Aware® of America’s

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Military Fee Assistance program for any reason.

Due to the variation in oversight and regulation in different states and based on official guidance from the branches of U.S. Military, Child Care Aware® of America

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reserves the right to determine which types of child care providers in each state meet the minimum eligibility requirements for participation in Child Care Aware® of

America Military Fee Assistance Programs.

Provider/program will provide all information requested by Child Care Aware® of America, continue to meet all minimum licensing requirements set by the state and

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agrees to comply with all Child Care Aware® of America Military Programs’ policies necessary for reimbursement and must be able to receive Federal subsidy by state

or federal law.

The Service Member and Provider/Program must be determined and remain eligible to receive reduced-fee child care through Child Care Aware® of America Military

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Programs.

Provider/program agrees that they have read, understand, and agree to adhere to all of the payment policies necessary for reimbursement for Child Care Aware® of

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America’s Military Fee Assistance Programs. (Please visit

to read the Payment Policies for all branches.)

Provider/program, understands that the correct Tax Identification (TIN) Number must be provided to Child Care Aware® of America. Failure to provide the correct TIN

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number and billing information will result in provider/program being held financially responsible for any penalties incurred from the Internal Revenue Service (IRS).

Child Care Aware® of America reserves the right to check the validity of all documentation related to a provider/program’s application, payment, eligibility, child care

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rates, attendance records and any other information related to child care services and fee assistance at any time through such methods including but not limited to

secret shopper calls, emails, phone, fax and U.S. mail.

Provider/Program understands that their state licensing inspection/compliance history will be reviewed at the time of their initial application and at least once per year

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and will be used to determine eligibility

Provider/Program understands that probation or disqualification from Child Care Aware® of America’s Military Fee Assistance Programs may occur due to inspection

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violations (corrected or uncorrected; self-reported or filed as a complaint), complaints (substantiated or unsubstantiated), and violation of fee assistance policies.

Violations of fee assistance policies or licensing violations that fall into this category include but are not limited to: corporal punishment/inappropriate discipline, lack of

supervision, background check deficiencies of any kind, knowingly employing individuals with failed background checks or a criminal record, negligence, child abuse,

CPS investigations, state license suspension/revocation, involvement of drugs/alcohol, training deficiencies of any kind, CPR/First Aid, SIDS, noncompliance with child-

teacher ratio regulations, criminal activity, out of minimum compliance with the state, non-conformity with licensing regulations, minimum sanitation requirements,

transportation violations of any kind, repeat violations of any kind, fraud of any kind (substantiated or suspected by a legal local/state/federal agency and/or Child

Care Aware® of America), submission of false information, unresolved complaints made by parents, failure to report changes in a timely manner,

unreasonable/exorbitant child care rates for market in question, etc. (Violations or complaints not listed here specifically are also taken into consideration.).

Provider/Program must provide proof that all staff and volunteers have an Advanced FBI Federal Fingerprint Background Check along with a Child Abuse Registry check

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conducted and adjudicated by their state agency. If care is home-based, provider must provide proof that all staff, volunteers and adults (18 years and older) residing

in the family child care home have an Advanced FBI Federal Fingerprint Background Check along with a Child Abuse Registry Check conducted and adjudicated by their

state agency. Provider/Program will be allowed a 75 day period to complete all outstanding background checks, with results returned to Child Care Aware® of America.

Failure to comply with all background check requirements will result in disqualification from the program.

Provider/Program understands that Background Checks can include but are not limited to the following: FBI Fingerprint Criminal History, State Criminal History, State

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Child Abuse and Neglect Registry, State Sex Offender Registry, National Sex Offender Registry, State/County Court Records, etc.

Provider/Program understands that ALL background checks submitted may be reviewed for program participation suitability as stated in the Department of Defense

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Instruction (DoDI).

Provider/Program must maintain an accurate and current staff list to include all employees, assistants and volunteers. All changes to the staff list must be reported to

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Child Care Aware® of America within 48 hours.

Provider/Program is required to report to Child Care Aware® of America any circumstances that would change the results of background checks for themselves, staff or

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household members within 48 hours of incident.

The U.S. Navy, U.S. Air Force, U.S. Marine Corps reserve the right to inspect any community-based program participating in the fee assistance program at any time.

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Provider/Program understands that background checks must be completed for family child care providers, staff, and household members to participate at the time of

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application. Background Checks must be initiated for child care center staff and must be completed within 75 days at the time of application in order to participate.

Provider/program(s) placed on a probationary status will remain on probation for no less than one year. Military families will be able to attend the facility and receive

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fee assistance but will be approved on a case-by-case basis. Provider/program(s) status will automatically be re-evaluated at the end of the probationary period to

determine if status should be lifted or extended.

Provider/program(s) that are disqualified from all Military Fee Assistance programs will be suspended from receiving fee assistance for a period of no less than one year

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to indefinitely. Provider/program(s) that are not disqualified indefinitely will automatically be re-evaluated at the end of the disqualification period to determine if

status should be lifted or extended.

Provider/Program understands that Child Care Aware® of America will NOT pay the entire cost of child care for approved families participating in the Military Fee

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Assistance programs.

I understand that program or policy violations will result in having to repay money to Child Care Aware® of America Fee Assistance and/or suspension from future

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participation in the Child Care Aware® of America Fee Assistance Programs.

I have read all of the above and understand its content. I also understand that non-compliance with any of the above may result in termination of my participation in CHILD CARE AWARE® OF AMERICA Military

Programs.

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Printed Name

Signature

Date

(Provider/Program Owner or authorized agent of owner)