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A. State Income Eligibility Scale for Child Care Subsidy B. Family Copayment Scale for Child Care Subsidy C. Child Care Program Budget Lines D. Child Care Program Cost Code Descriptions E. Maximum Reimbursable Rates Per Type Of Provider F. Level 1 Maximum Reimbursable Rates G. Level 2 Maximum Reimbursable Rates H. Barrier Crimes for Child Day Programs I. Forms Used in Child Care Subsidy Program J. Child Care Subsidy Service Application and Redetermination Form (032-25-0147-04-eng (07/18)) Instructions K. Child Care Waitlist Screening Form (032-05-0547-02-eng (03/17) Instructions L. Child Care Waitlist Update Form (032-12-0132-00-eng (08/17) Instructions M. Child Care Notice of Action Form (032-12-0128-01-eng (07/18)) Instructions N. Child Care Notice of Redetermination Form (032-12-0131-00-eng (08/17) Instructions O. Child Care Communication Form (032-05-0518-02-eng (07/18) Instructions P. Child Care Verification Checklist (032-12-0127-00-eng (03/17) Instructions Q. Childhood Immunization Certification (032-03-960-03-eng) Instructions R. Child Care Purchase of Service Order (032-05-0540-01-eng (07/12) Instructions S. Child Care Repayment Agreement Form (032-12-0130-00-eng (08/17) Instructions T. Child Care Case Record Transfer Form (032-25-0148-00-eng (07/18) Instructions U. Child Care Notice of Case Transfer Form (032-25-0149-00-eng (07/18) Instructions V. Vault ECC Card Issuance Authorization Form (032-12-0137-00-eng (02/20) Instructions W. Vault ECC Card Inventory Control Record Form (032-12-0138-00-eng (02/20) Instructions X. Monthly Vault ECC Card Used Report Form (032-12-0139-00-eng (02/20) Instructions Y. Authorization to Act as Agent on Customer’s Behalf for In-Home Care (032-05-0061-03-eng (09/20) Z. Metropolitan Statistical Area Groupings