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Child Care Subsidy Policy October 1, 2024 132 14.4.34. ECE-CC-23 Fire Escape Plan. Providers may use this form to assist in preparing fire escape routes and record fire drills. 14.4.35. ECE-CC-24 Emergency Phone List. Providers may use this form to compile an emergency phone list. 14.4.36. ECE-CC-25 Medication Permission Slip. Providers may use these permission forms with parents to record medication dosages and times. 14.4.37. DAY-0615 Corrective Action Plan. This report may be generated by PATH whenever completion of a regulatory checklist reveals areas of non-compliance. The corrective action plan shall be sent to the provider as a formal notice that the provider is out of compliance and listing the steps that must be taken for the provider to correct areas of non-compliance. 14.4.38. W-9 Tax Identification Form. This form will be completed at provider application/enrollment and signed by the provider. The CCR&R case manager will send the original to the DoHS Child Care Worker, who shall enter the appropriate information on the PATH tax information screen. The PATH provider case number shall be added to the top of the form and the form forwarded to Bureau for Family Assistance. A revised form will need to be completed by the provider whenever there is a name or address change, even if the provider moves out of West Virginia. 14.4.39. DAY-0618 Notification of Provider Approval Status. This is a PATH-generated notice for in-home and unlicensed school-age child care providers who are exempt from regulation under WV Code, Chapter 49-2B, but must meet requirements to participate in the child care certificate program. 14.4.40. ECE-CC-26 Incident Report Form. Providers may use this form to record and report incidents the result in injury to a child. Incidents must be verbally reported within 24 hours. Providers are requested to follow up in writing within 72 hours. 14.4.41. ECE-CC-27 Direct Deposit Information/Application. CCR&R staff shall provide this form to all new providers enrolled for payment. The form explains the process for direct deposit and includes the application form that is to be returned to the Auditor’s Office. 14.4.42. ECE-CC-30 Periodicity Schedule. Child care providers are required to give a copy of this form, which contains a recommended schedule of health check-ups and immunizations, to each child care parent.