Provider Cost Verification Form - ChildCare Aware of America

Submit the Provider Cost Verification Form along with the family application to ChildCare Aware of America. You can email the form to feeassist@childcareaware.org, fax it to 1-866-662-2246, or mail it to ChildCare Aware of America, 1515 N Courthouse Rd, 3rd Floor, Arlington, VA 22201. Ensure all information is accurate and complete before submission. My advice is to double-check all details to avoid any delays or issues with the application process.

Important dates for this form in 2024 and 2025 will be determined based on the fee assistance program's requirements. Ensure timely submission to avoid delays.

The Provider Cost Verification Form is essential for processing fee assistance applications for child care services. It collects information about child care rates, discounts, and the schedule of care to ensure accurate processing. By submitting this form, families can determine their eligibility for fee assistance and avoid overpayments.

• 1. Child Care Facility Name: The name of the child care facility providing care.
• 2. Provider ID#: A unique identifier for the child care provider.
• 3. Child Care Director/Point of Contact: The name of the individual responsible for the child care facility.
• 4. Provider Address: The address where child care is provided.
• 5. City: The city where the child care facility is located.
• 6. State: The state where the child care facility is located.
• 7. Zip Code: The postal code for the child care facility's location.
• 8. Provider Phone Number: The contact phone number for the child care provider.
• 9. Sponsor Name: The name of the individual sponsoring the child's care.
• 10. Family ID#: A unique identifier for the family seeking fee assistance.
• 11. Rate Information: Details about the child's name, days of care, hours of care, and rates before and after discounts.
• 12. State Subsidy Received: Indicates if a state subsidy is received and includes the voucher if applicable.
• 13. Rate Frequency: The frequency of the rate, such as weekly, monthly, or annually.
• 14. Effective Date: The start date for the provided rate information.
• 15. Start of Care Date: The date when the child's care begins.
• 16. Annual Registration Fee: The annual registration fee for the child care facility.
• 17. One Time Registration Fee: A one-time registration fee for the child care facility.
• 18. Discounts: Description of any discounts given.
• 19. Rate Changes within the Next 12 Months: Information about any rate changes expected within the next 12 months.
• 20. I certify that all above information is correct: Certification statement indicating the information provided is accurate.
• 21. Signatures: Signatures from the child care director and the parent/guardian.

Failure to submit the Provider Cost Verification Form may result in ineligibility for fee assistance and potential overpayments.

• Ineligibility for Fee Assistance: Families may not qualify for fee assistance if the form is not submitted.
• Potential Overpayments: Accurate fee calculations may not be possible, leading to overpayments.

• 1. Applying for Fee Assistance: Submit this form when applying for child care fee assistance.
• 2. Verifying Child Care Rates: Use this form to report accurate child care rates and discounts.