Child Care Assistance Application printable pdf download

Child Care Assistance Application

CHILD CARE ASSISTANCE APPLICATION

Instructions:

Please read the application carefully. Complete all sections of the application. Answer each question completely and to the best of

your ability. List everyone in your household. Please print clearly.

The child care application asks you to give us the social security number for everyone in your household. Social security numbers

will help us to process your case more quickly. We will only use your social security number in the administration of the Child

Care Subsidy Program to help us verify your income, make changes in your case and help us assemble research data. If you do not

want to give us the social security number for a member of your household your application for child care will not be denied and

services will not be withheld because you do not give us a social security number.

If you should choose not to give the social security number for some members of your household you must still answer questions

about his or her income and answer the other questions on this form.

Take or mail this application to your local Child Care Management Agency.

DHR-CMA-1973 (April 2002)

Child Care Assistance Application