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4200-6 A. REVIEWING AN ACCEPTABLE LICENSED, CERTIFIED/ACCREDITED PROVIDER CHILD CARE ASSISTANCE APPLICATION FOR COMPLETENESS The Designee does not ensure Licensed, United States (US) Department of Defense or US Coast Guard Certified, Tribally Approved or Tribally Certified, Nationally Accredited or Nationally Certified Day Camp or similar facility provider applicants have obtained the required State of Alaska business license. Business licenses for these provider types is monitored by the child care licensing office or applicable accrediting, certifying or approving office.

The Designee will review an acceptable application and supporting documentation to include the following steps prior to determining an application complete: 1. Licensed Provider Child Care Assistance Application CC41or Certified/Accredited Provider Child Care Assistance Application CC84

Ensure the Licensed Provider Child Care Assistance Application CC41 is filled out completely and the Statement of Truth section of the application has been signed by the facility owner or Administrator reflected in the Integrated Child Care Information System (ICCIS), attesting they have read, understand and agree to abide by the rules pertaining to program participation. If there are applicable areas not marked, a copy of the form is retained, and the original is returned to the applicant to be completed.

2. Child Care Provider Rates and Responsibilities CC12 Ensure the provider has completed the top portion pertaining to their facility name; contact phone number; physical, mailing, and email addresses; owner name, owner physical, mailing, and email addresses and has marked the applicable box for Provider Type.

Ensure the provider has also completed the rate portion by either checking the box indicating the provider’s charges are the same as the State subsidy rate with or without exceptions for specific age groups or levels of care, or by marking the box “My rates are listed below” and completing all applicable information.

3. State of Alaska Substitute Form W-9 This is a State of Alaska, Department of Administration, Division of Finance form used by all vendors of the State of Alaska. Ensure the provider’s business type is identified as well as theirTaxpayer