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Title 13: Social Service Resources Page 111 Iowa Department of Health and Human Services Employees’ Manual Chapter G: Child Care Assistance Authorizing Services Revised June 14, 2024 Child Care Assistance Provider Agreement ▪ The second time the agreement is terminated, the provider may not reapply for another agreement for 12 months from the effective date of termination. ▪ The third and subsequent time the agreement is terminated, the provider may not reapply for another agreement for 36 months from the effective date of termination. The Department shall not act on an application for a Child Care Assistance Provider Agreement submitted by a provider during the sanction period. Completing the Agreement Policy: The Child Care Assistance Provider Agreement, form 470-3871 or 470-3871(S), must be prepared: ▪ At least every 24 months, or ▪ When there is a change in circumstances that requires a change to the form. Procedure: The child care provider shall complete all information on page one as requested (except for the agreement number), sign the form, and return the form to the Department’s CCA worker. If the form is returned to the PROMISE JOBS office, it will be forwarded to the Department’s CCA worker for processing. (PROMISE JOBS workers do not complete this form.) The Department worker: ▪ Reviews the form to ensure that page one is completely filled out, and that the provider has signed the form. ▪ Reviews the provider’s rates. ▪ Completes the third column of the table on page two with the approved half-day unit rates for each age group. ▪ Completes the “Other rates” section with the approved half-day unit rate for each discount rate reported by the provider on page one. The Department’s Child Care Assistance (CCA) worker then signs form 470-3871 or 470-3871(S), Child Care Assistance Provider Agreement, and returns a copy to the provider. Form 470-3871 or 470-3871(S) is not valid unless both the provider and the Department’s worker have signed it. Refer to 14-H, KinderTrack System for complete instructions for entering agreements.