Provider Checklist

Provider Checklist.pdf

Childcare Application

Provider Checklist

OMB: 3045-0142

Document [pdf]
Download: pdf | pdf
To complete your application, please ensure you have submitted copies of the following
documents:
☐ Child care providers Social Security number or TIN.
☐ License, registration or certificate of exemption.
☐ IRS W-9 form.
☐ Direct Deposit form if applicable.
Please Note:
The above list includes the basic documentation needed to complete an application. Depending
on individual circumstances additional documentation may be required.


File Typeapplication/pdf
AuthorMeagan MD. Daniels
File Modified2012-01-12
File Created2011-11-15

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