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Child Care Subsidy Policy October 1, 2024 128 14.4. Child Care Forms and PATH Reports for Providers 14.4.1. DAY- 0503 Notification of Provider Regulatory Status This PATH generated letter is sent to registered and licensed child care providers to notify them of information regarding the regulatory and/or monitoring process. 14.4.2. ECE-CC-3B Statement of Good Health This form shall be completed by an approved health care provider for informal and relative child care providers at the time of registration and every two years thereafter. In-home child care providers are also required to obtain a Statement of Good Health at the time of their approval. 14.4.3. ECE-CC-3C Medical Report for Child Care Provider This form shall be completed by registered family child care providers at the time of registration and every two years thereafter. 14.4.4. ECE-CC-4 Child Care Provider File Cover Sheet CCR&R case managers use this form to notify regulatory specialists of any concerns with child care provider applications taken during orientation. 14.4.5. DAY-0546 Child Care Services Agreement with Provider The CCR&R case manager must be certain that the provider clearly understands all aspects of the PATH generated Provider Services agreement. The CCR&R case manager should have the provider sign an original and two (2) copies. The original copy shall be retained in the legal block of the provider file, a copy shall be given to the provider and a copy shall be sent to the DoHS Child Care Worker. The contract may be cancelled by either party, with or without cause, upon notice. The contract should be updated every 2 years. CCR&R agencies should set up internal processes to ensure that agreements are renewed every two years. 14.4.6. ECE-CC-6A Payment Processing Training Certification This form shall be signed by all child care providers who go through training on the payment process to confirm that they not only received the training but understand it and agree to keep accurate records. 14.4.7. ECE-CC-6E Health and Safety Requirements for In-Home Child Care Providers This form is a checklist and shall be completed by in-home family child care providers to receive child care certificate program funds. These standards are part of the Provider Services Agreement (DAY-0546). West Virginia does not license or certify this type of child care provider. 14.4.8. ECE-CC-6IR Health and Safety Checklist for Informal and Relative Family Child Care Providers This checklist shall be given to applicants for registration as an informal or relative family child care provider. The form shall be completed and returned within 30 days to the child