CHILD DEVELOPMENT AND CARE PROVIDER VERIFICATION INSTRUCTIONS: Due Date: Complete the form below. 5. . For Orientation, select "Learn about Orientation". Summer 2022 Child Care Stabilization Grants:To go directly to information about the Summer 2022 grants, click the following link: Summer 2022 Child Care Stabilization Grants. Phone: 517-335-3704 for Deed, Promissory For the Quality Rating Process, select "Learn about Participating". As soon as you are confident the sample is what you need, click on Buy Now. Will, Advanced We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use. Information on communicable & chronic diseases. The Child Care Licensing Bureau issues licenses to Family Child Care Homes, Group Child Care Homes, and Child Care Centers. Do you need childcare? PURPOSE:You have received this form because you have applied for assistance with child care expenses through the Child Development and Care (CDC) program or have changed your CDC provider. j|5p5Cne_/dW9dU"]]o` Options available for Michigan students that provide unique learning opportunities. The notice will include the reason for your ineligibility. Legislation policy and planning information. Visit your local MDHHS Officefor forms or applications not available online. The form must be signed by one of the following: A physician (M.D. A: For more information about GSQ Orientation or the Quality Rating process, please call 877-614-7328 or visit Great Start to Qualityand click "Providers and Educators". The provider or applicant is responsible for this cost. See the CDC Handbookfor more Level 2 training requirements and information. Will, All CDC specific instructional videos include: Theseinstructional videosprovide helpful information and resources to support providers with billing and payments. Learn more about the MDE office responsible for providing leadership in curriculum and instruction that provides students with greater choices to prepare for success. This form must be completed and signed by your childcare provider. Low-income Households Water Assistance Program (LIHWAP). There are multiple instances where a person may be found ineligible to be a licensed child care provider. State(s) Child Abuse and Neglect Registry Check. A form for providers to keep time and attendance records when the child(ren) are in care. Service, Contact News, Events & Conferences collapsed link. Complete the top portion of this form and have your child-care provider complete the remainder. Only available for licensed providers. Begin a Michigan criminal history check by visiting The Michigan State Police (MSP)Internet Criminal History Access Tool (ICHAT) website. 11 Year Winner in all Categories:Forms, Features, Customer Serviceand Ease of Use. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Is Michigan a National Fingerprint File (NFF) state? 3-21), MDHHS-5598, American Indian/Alaska Native Child/Parent Ancestry Verification (Rev. Child care providers are required to immediately report incidents of serious injury or death of a child in care. Home to an array of public health programs, initiatives and interventions aimed at improving the health and well-being of women, infants, families and communities. Michigan State Police General Provisions - BCAL-1888, Child Care Center Compliance Record, Part 2. Agreements, Corporate Planning, Wills This is a legal form that was released by the Michigan Circuit Court - a government authority operating within Michigan. Informe de Lesiones Graves Deasarrollo y Cuidado Infantil (CDC). A response will be sent within tenworking days. 422 0 obj <>/Filter/FlateDecode/ID[<0F81578DBFE6954F99F1EC432DAA92DB><7E632B1BD3414B40A955C0CD1B8CF54C>]/Index[399 49]/Info 398 0 R/Length 104/Prev 73169/Root 400 0 R/Size 448/Type/XRef/W[1 2 1]>>stream No. Information on the Children's Protective Services Program, child abuse reporting procedures, and help for parents in caring for their children. Read description and preview the template. Fax: 517-763-0280, Website: MDHHS - Central Registry Clearance Requests, Forms: Central Registry Clearance Request - DHS-1929. The pay period number (see Payment Schedule). FORM TITLE & DOWNLOAD LINK Things You Should Know About the 2017 Michigan Child Support Formula: Request to Set Support at Zero: Request for "Matching" Payment: FOC Case Questionnaire: Request to Discharge State Owned Debt: Child Care Verification Form: Request for Child Support Review: Objection to Child Support Review: Motion Regarding . Family and Group Home Increased Capacity and Ratio Request - Word Version, Family and Group Home Increased Capacity and Ratio Request PDF Version, Waiver for Decreasing Capacity Fillable Word Version, Waiver for Decreasing Capacity PDF Version, Request of Child Care Forms CCL-2021 PDF, Request of Child Care Forms CCL-2021 Word, Child Care Licensing Information Request - CCL 001 -PDF, Child Care Licensing Information Request - CCL 001 - Word, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 PDF, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 Word, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - PDF, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - Word, Background Check and Fingerprinting Information, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200, Notification of Changes in Status-Family and Group Child Care Home - CCL-1485 - PDF, Notification of Changes in Status-Family and Group Child Care Home - CCL-1485 - Word, Medical Clearance Request - CCL-3704 - PDF, Medical Clearance Request - CCL-3704 - Word, Child Information Record - CCL-3731 - PDF, Child Information Record - CCL-3731 - Word, Child Information Record - CCL 3731-AR (Arabic), Documento de Informacin del Nio Estado de Michigan - CCL-3731-SP, Zoning Approval for Group Child Care Homes - CCL-3748 - PDF, Zoning Approval for Group Child Care Homes - CCL-3748 - Word, Declaracin/Recibo de Nios en Cuidado - CCL-3900-SP, Child in Care Statement/Receipt - CCL-3900 - PDF, Child in Care Statement/Receipt - CCL-3900 - Word, Training Record Family/Group Child Care Homes - CCL-4590 PDF, Training Record Family/Group Child Care Homes - CCL-4590 - Word, Assistant Caregiver Certifications - CCL-4595 - PDF, Assistant Caregiver Certifications - CCL-4595 - Word, Home Fire and Tornado Drill Record - CCL-4593 - PDF, Home Fire and Tornado Drill Record - CCL - 4593 - Word, Licensing Notebook Summary Sheet - CCL-5052 - PDF, Licensing Notebook Summary Sheet - CCL-5052 - Word, Request for Modification of the Terms of the License - CCL-5054 - PDF, Request for Modification of the Terms of the License - CCL-5054 - Word, Variance Request Early Childhood Program Director Fillable Word Version, Variance Request Early Childhood Program Director PDF Version, Variance Request School-Age Program Director Fillable Word Version, Variance Request School-Age Program Director PDF Version, Variance Request Lead Caregiver Fillable Word Version, Variance Request Lead Caregiver PDF Version, Child Care Licensing Information Request - BCHS-CCL 001 - PDF, Child Care Licensing Information Request - BCHS-CCL 001 - Word, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 - PDF, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 - Word, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - Word. forms in this package! Dimondale, MI 48821 Forms, Independent Form 1310 Bank Statement Verification - Michigan, Form 1309 Account Receivable Verification - Michigan, Form H1135 Child Care Expense Verification - Texas (English/Spanish), Form H1135 Child Care Expense Verification - Texas, Form CC59 Child Care Center - Child Care Associate Reference - Alaska, Form 1863 Child Care Provider Verification - New Hampshire, Child Care Verification of Reopening - Maryland. 0 Estate, Public Out-of-state entities requesting Central Registry clearances for the reasons outlined in Section IV. Self-Certification of Transportation Provisions for Centers CCL-5044 - Word, Volunteer Certification for Field Trip Transportation CCL-5046 - PDF Forms, Small Select a subscription plan that really works for your budget. hb```f``V @VEv :;@"@H (X$iv wp(K*00nei``N4 hWyQp4#5 .N Instructionalvideosare available for free to CDC providers. Child Development and Care Internet Billing. Child Development and Care ProviderVideo #2: Child Development and Care ProviderVideo #3: Child Development and Care ProviderVideo #4: Child Development and Care ProviderVideo #5: Child Development and Care ProviderVideo #6: Child Development and Care ProviderVideo #7. Information on the Safe Delivery Program, laws, and publications. (S or C-Corps), Articles 2-19a), DHS-990-SP, Relative Notification Letter (Spanish), DHS-990-AR, Relative Notification Letter (Arabic), DHS-3200, Report of Actual or Suspected Child Abuse or Neglect, DHS-3200-SP, Report of Actual or Suspected Child Abuse or Neglect (Spanish), DHS-3200-AR, Report of Actual or Suspected Child Abuse or Neglect (Arabic), State of Michigan Sudden & Unexplained Child Death Scene Investigation Form, DHS-3043, Earned Income Tax Credit Temporary Assistance for Needy Families (TANF), DHS-3043-SP, Asistencia Federal Temporal a Familias Necesitadas (TANF) Determinacin de Elegibilidad, DHS-1514-SP, Solicitud Para Ayuda de Emergencia del Estado, MDHHS-6039, Family Preservation Contracted Universal Referral, DHS-229, Families First of Michigan Initial Service Plan, DHS-408, Family Reunification Program, Updated Service Plan, DHS-411, Family Reunification Program, Initial Service Plan, DHS-535, Termination Report (Families Together Building Solutions), DHS-528,Families Together Building Solutions Updated Service Plan, DHS-523, Families Together Building Solutions Initial Service Plan, MDHHS-5921, Youth Health Information for Residential Discharge, MDHHS-5922, Youth Health Information for Residential Referral, MDHHS-5922-A, Youth Health Information for Residential Intake, DHS-3005, Recommendation and Assurance for Pre-Adoption and Requirement Certification, DHS-3750, Sending State Priority Home Study Request, DHS-4332, Interstate Compact Placement Request, DHS-4333, Interstate Compact Report on Child's Placement Status, DHS-4336, Interstate Compact on the Placement of Children Placement Prescreening, MDHHS-5944, Interstate Commission for Juveniles (ICJ) Return Placement Invoice, Adult Foster Care and Homes for the Aged rules and statutes, BCAL-PUB-339, License Renewal Inspections, CWL-4606, Child Welfare Licensing Placement Assistance Request, CWL-4618, Disciplinary Action Unit Denial/Provisional/Revocation Checklist, CWL-4006, Variance Request for CAP/CCI/COF Rules, CWL-4607-CON, Chief Administrator Annual Assessment and Corrective Action Plan (Public and Contract Child Placing Agency), No Contract CPA Audit Workbook (Rev. THE MICHIGAN CHILD SUPPORT FORMULA AND/OR SPOUSAL SUPPORT . Federal Bureau of Investigation (FBI) fingerprint-based check of criminal history. Templates, Name Resources for supporting special education in Michigan. To submit billing for a child receiving Child Development and Care (CDC) assistance, go to the I-billing login page. Find appropriate billing examples for absence hours when using the I-Billing system. LLC, Internet Bridge Card Participation Information on Electronic Benefits for clients and businesses, lists of participating retailers and ATMs, and QUEST. 10-22), DCH-1426, Health Coverage & Help Paying Costs Application, DHS-PUB-280, Reporting Changes When, How & What to Report, DHS-PUB-280-SP, Reporting Changes When, How & What to Report (Spanish), DHS-PUB-783, MDHHS Can Help with Temporary Assistance, DHS-8-A, Irrevocable Funeral Contract Certification, DCH-1183, Authorization to Disclose Protected Health Information, DHS-848, Certification of Translation for Non-English Speaking Applicants or Recipients, DHS-1327, Prevention Services - Family Goals and Progress Tracker, DHS-1328, Referral for Prevention Services, MDHHS-5973, Home Visiting Program Referral, DHS-1555-HV, Authorization to Release Confidential Information - Home Visiting Programs, DHS-4819, Voluntary Medical Background Form, DHS-4819-SP, Forma Voluntaria de Antecedentes Medicos para un Recien Nacido Entregado, DHS-4820-SP, Entega Voluntaria Para Adopcion De Un Recien Nacido Por Parte De Un Padre, DHS-1182-A, Volunteer Registration Record Ongoing Volunteers, DHS-1182-B, Volunteer Registration Record Short Term Volunteers, DHS-1182-C, Volunteer Registration Record Group Volunteers, DHS-1929-SP, Central Registry Clearance Request (Spanish). You must meet requirements and apply to become a license exemptprovider in order to receive assistance payments for a child that you care for. Child Care Licensing Search Department of Licensing and Regulatory Affairs Statewide Search for Licensed Child Care Centers and Homes Search by one or more of the following choices: Facility Name Facility Status Facility Address County City Zip Code Licensee Name: License Number: Reset Estates, Forms 3-21), DHS-384, Native American Outreach Services Packet Cover (Rev. Complete this form within 72 hours of calling in a suspicion of abuse or neglect. Instructions for completing an Internet Billing form. The department does not charge for the processing of child care fingerprints. Real Estate, Last Download a fillable version of Form FOC39E by clicking the link below or browse more documents and templates provided by the Michigan Circuit Court. Ejemplos de facturacion: Ausecias de nios. Reducing Barriers to Licensure for Military Families, Corporations, Securities & Commercial Licensing, Find / Verify a Licensed Professional or Business, Make a Complaint About a Licensed Professional or Business, Look Up Underground Storage Tank Information, Access the Online Liquor Ordering (OLO) System, Regulated Products, Professions, & Businesses Activities, Resources for Veterans & Military Families, https://dev.michigan.local/som/json?sc_device=json, Playground Inspection Certification Summary CCL-5047 Word, Go to An Online Resource for Skilled Immigrants, Medical Marijuana Program (MMMP) Patients & Caregivers, Learn About CRA Rules, Laws & Regulations, Find / Verify a CRA Licensed Professional or Business, Make a Complaint About a CRA Licensed Professional or Business, Track Marijuana Inventory - Statewide Marijuana Monitoring System (Metrc), Find Panel, Public Hearing & Workgroup Information, Find a Disciplinary Action Report or Document, Learn About CCL Rules, Laws & Regulations, Find / Verify a CCL Licensed Professional or Business, Make a Complaint About a CCL Licensed Professional or Business, Apply for / Renew a BCC License or Permit, Find / Verify a BCC Licensed Professional or Business, Make a Complaint About a BCC Licensed Professional or Business, Learn About Examinations & Continuing Education, Find / Verify a BCHS Licensed Professional or Business, Make a Complaint About a BCHS Licensed Professional or Business, Go to Corporations, Securities & Commercial Licensing, Find / Verify a CSCL Licensed Professional or Business, Make a Complaint About a CSCL Licensed Professional or Business, Contact the Michigan Liquor Control Commission, Local Government & Law Enforcement Resources, Go to Michigan Office of Administrative Hearings and Rules, Administrative Hearings Frequently Asked Questions, Request to Attend a Hearing (for Media Professionals), Go to Michigan Indigent Defense Commission, Learn About Continuing Legal Education (CLE), Make a Complaint or Inquiry About a Utility Provider, Compare Natural Gas Utilities Options (MI Gas Choice), Submit an Underground Utilities Locate Request (MISS DIG 811), Learn About Natural Gas & Pipeline Providers, Learn About Rules of Practice and Procedure, Find / Verify a BPL Licensed Professional or Business, Make a Complaint About a BPL Licensed Professional or Business, Michigan Automated Prescription System (MAPS), Find / Verify a UCC Licensed Professional or Business, Make a Complaint About a UCC Licensed Professional or Business, Go to Apply for / Renew a License or Permit, Go to Find / Verify a Licensed Professional or Business, Go to Make a Complaint About a Licensed Professional or Business, Go to Look Up Underground Storage Tank Information, Go to Look Up a Controlled Substance (MAPS), Go to Access the Online Liquor Ordering (OLO) System, Go to Look Up a Disciplinary Action Report, Go to Submit a Request for Information (FOIA), Go to Regulated Products, Professions, & Businesses Activities, Go to Requesting Information from LARA (FOIA), Go to Resources for Veterans & Military Families, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 - Spanish, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 - Arabic, Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591 - PDF, Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591 - Word, Staffing Plan: Child Care Center CCL-5001 - PDF, Staffing Plan: Child Care Center CCL-5001 - Word, Staffing Plan: Child Care Center CCL-5001 Excel, Child Care License Designee CCL-5003 - PDF, Child Care License Designee CCL-5003 - Word, Certification of School Building Fire Safety Provisions CCL-5043 - PDF, Certification of School Building Fire Safety Provisions CCL-5043 - Word, Self-Certification of Transportation Provisions for Centers CCL-5044 - PDF, Self-Certification of Transportation Provisions for Centers CCL-5044 - Word, Volunteer Certification for Field Trip Transportation CCL-5046 - PDF, Volunteer Certification for Field Trip Transportation CCL-5046 - Word, Playground Inspection Certification Summary CCL-5047 - PDF, Family and Group Child Care Home Compliance Record - BCAL-4601, Preparing for Your License Renewal Fire Safety Inspection - BCAL-5048, Child Care Center Compliance Record, Part 1. Custom Toll-Free Phones Number: 866-813-0011. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Name Change, Buy/Sell or D.O. For reimbursement, please go to the Provider Resources section and review the I-Billing instructions and Billing help information. Q: What if I am found ineligible prior to fingerprinting? Agreements, LLC & Estates, Corporate - Provider Billing and License Exempt Provider Information You must meet eligibility requirements to become a license exempt provider in order to receive assistance payments for a child that you care for. Planning Pack, Home Child Care Verification Form. Review Package. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Each person who is put into the CCBC System must complete the Consent and Disclosure form, and provide all necessary information, forms, and fees necessary to complete the comprehensive background check. Apply to become a license exempt related or unrelated child care provider. This Child Care Verification form is used to notify the Court, as well as the opposing party, that child care is in place for the minor child or children. Mi Kids Matter is your place to find what you need to give your child their best chance at health, happiness, and success later in life. A 14 year-old is a teenager and would not generally be referred to as a child. As of today, no separate filing guidelines for the form are provided by the issuing department. MiChildSupport Public Calculator - The official child support calculator using the Michigan Child Support Formula State Court Administrative Office - Friend of the Court Bureau Contact Us 269-383-8837 Jury Services Family Division Friend of the Court 1-877-543-2660 Juvenile Home 269-385-8550 ,:}3-"k,.Q$'MBsjz0MpfUSVR^JEJy-L'~ 3rj How much does a Child Care Background Check Cost? Spanish, Localized Planning Pack, Home IMPORTANT: New information regarding level 2 training for License Exempt-Related and License Exempt-Unrelated subsidy providers. 6. Solicitud de Proveedor Exento de Licencia para Desarrollo y Cuidado Infantil (CDC). Children's Protective Services Program The form must be completed and returned within ten calendar days. Liens, Real Visit Michigan's Public Sex Offender Registry (PSOR) to begin a search. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Every learner in Michigans public schools will have an inspiring, engaging, and caring learning environment that fosters creative and critical thinkers who believe in their ability to positively influence Michigan and the world beyond. Upgrade and Save: This form is part of a package. Save: This form is part of a package. Michigan has an innovative and comprehensive system of assessments to measure student achievement in learning our state content standards. 517-322-2521. Child Care Call Center Hours: Beginning Monday August 16, 2021, CDC will have new call center hours. Information about the health care programs available through Medicaid and how to qualify. Once your reusable form is downloaded, print it out or save it to your device. Birth, Death, Marriage and Divorce Records. 608 W. Allegan Upon returning the completed eligibility verification form, the Child care background checks are completed on the following individuals: An adult member of the household shall not move into the home of a licensed child care provider until they have completed a child care background check and been found eligible by the department. 8 Properties: Verification - Disability for Section 202-8 Properties Please call 866-990-3227 for questions. e842, Child Support Response Form If you are not receiving public assistance, complete this form to provide additional information to your caseworker. To learn more about participating in Great Start to Quality visitGreat Start to Quality - Find High Quality Child Care in Michiganor contact 877-614-7328. Information and Resources- If you are a licensed child care provider, or wish to become one, we encourage you to take advantage of our information and resources to help you provide quality care. Information on adoption programs, adoption resources, locating birth parents and obtaining information from adoption records. Information is collected to monitor the general health and well-being of Michigan citizens. Go to the License ExemptProvider Application to begin the process. Becoming a licensed child care facility requires a background check. Return the completed form to your specialist in the local DHS office. The Word documents are fillable and are intended for electronic completion.
