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Title 13: Social Service Resources Page 78 Iowa Department of Health and Human Services Employees’ Manual Chapter G: Child Care Assistance Identifiying the Provider Revised June 14, 2024 Provider Requirements

PROVIDER TYPE REQUIREMENTS Nonregistered child care home ▪ Guidelines for Child Care Homes with a Child Care Assistance Provider Agreement, Comm. 95 ▪ Payment Application for Nonregistered Providers, 470-2890 or 470-2890(S) ▪ Child Care Assistance Provider Agreement, 470-3871 or 470-3871(S) ▪ Authorization for Release of Child and Dependent Adult Abuse Information, 470-3301 ▪ Completed Federal Fingerprint Card, form FD-258 ▪ Waiver Agreement and Statement, form DCI-45 ▪ Lead Assessment and Control, form 470-4755 or 470-4755(S) ▪ Criminal History Record Check Request Form, DCI-77 In-home care ▪ Payment Application for Nonregistered Providers, 470-2890 or 470-2890(S)

▪ Child Care Assistance Provider Agreement, 470-3871 or 470-3871(S) ▪ Authorization for Release of Child and Dependent Adult Abuse Information, 470-3301 ▪ Completed Federal Fingerprint Card, form FD-258 ▪ Waiver Agreement and Statement, form DCI-45 ▪ Criminal History Record Check Request Form, DCI-77 Out-of-state ▪ Written verification of license or registration issued by the other state ▪ Child Care Assistance Provider Agreement, 470-3871 or 470-3871(S) NOTE: A relative who is a registered provider must follow the requirements set forth for child development homes. A relative who is not registered must follow the requirements set forth for nonregistered child care providers.