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PURPOSE OF FORM The purpose of this form is to inform recipients of child care subsidy and services of the need to renew their eligibility for Child Care Subsidy and Services and that services will end if a redetermination application is not filed or if the application indicates the recipient is no longer eligible.

USE OF FORM The form notifies the recipient that a redetermination application must be filed to continue eligibility for Child Care Subsidy and Services. If the redetermination application is not completed, Child Care Services will be interrupted and/or discontinued.

COPIES The original will be mailed to the recipient. A copy of the notice must be filed in the case record.

INSTRUCTIONS FOR PREPARING THE FORM The Child Care Worker will complete the form and enter the date services will end as well as the date the redetermination application must be returned by (First day of redetermination month). The form must be sent with the Redetermination Application and at least 10 days in advance of the end of the redetermination month. Information will be preprinted on the form that is generated from VaCMS.

The last page of the form provides information on the fair hearings and appeal process.

Appendix O. Child Care Subsidy Program Communication Form Instructions

NUMBER 032-05-0518-02-eng (07/18)

PURPOSE OF FORM To notify applicant for/recipient of child care subsidy of a change in their application/case which does not affect eligibility, copayment or the amount of services authorized or to request information from the applicant/recipient.

USE OF FORM To communicate information to the applicant/recipient of an action to be taken or to request information.

COPIES One copy for the applicant/recipient. Copy is saved in the VaCMS for the case record.

INSTRUCTIONS FOR PREPARING THE FORM A Child Care Communication form is used to communicate to an applicant or recipient information related to their child care case that does not affect eligibility, copayment or the amount of services authorized. This form is intended for the applicant/recipient and should not be sent to anyone else.