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89

3.10. Forms Used In Service Planning

A. Required Child Care Forms

The Child Care Service Application and Redetermination Form (032-25-0147-06-eng (07/22)) is used for all applicants for child care services to provide documentation of eligibility requirements for subsidy services and assessment of need. This information must be completed at initial application or at redetermination. The Child Care Service Plan provides a place to record service planning and consumer education information. This information must be completed/updated as part of the eligibility determination/redetermination process and before authorization for child care services can be initiated. A copy must be given to the recipient. A more detailed description of the form and its uses is found in section 3.6 of this guidance.

The Child Care Notice of Action Form is used to notify applicants and recipients of case actions which affect eligibility for child care, copayment amounts or the amount of service authorized. A more detailed description of the form and its uses is found in section 3.11 of this guidance.

B. Optional Child Care Forms

The Child Care Communication Form is used to notify applicant for or recipient of child care subsidy of a change in their application/case that does not affect eligibility, copayment or the amount of services authorized.

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Page 89

Official source

89

3.10. Forms Used In Service Planning

A. Required Child Care Forms

The Child Care Service Application and Redetermination Form (032-25-0147-06-eng (07/22)) is used for all applicants for child care services to provide documentation of eligibility requirements for subsidy services and assessment of need. This information must be completed at initial application or at redetermination. The Child Care Service Plan provides a place to record service planning and consumer education information. This information must be completed/updated as part of the eligibility determination/redetermination process and before authorization for child care services can be initiated. A copy must be given to the recipient. A more detailed description of the form and its uses is found in section 3.6 of this guidance.

The Child Care Notice of Action Form is used to notify applicants and recipients of case actions which affect eligibility for child care, copayment amounts or the amount of service authorized. A more detailed description of the form and its uses is found in section 3.11 of this guidance.

B. Optional Child Care Forms

The Child Care Communication Form is used to notify applicant for or recipient of child care subsidy of a change in their application/case that does not affect eligibility, copayment or the amount of services authorized.