Childcare Benefit Forms

OMB 3045-0142

These forms are submitted by AmeriCorps members and by childcare providers for the purpose of applying for, and receiving payment for the case of children during the day while the AmeriCorps members are serving.

The latest form for Childcare Benefit Forms expires 2021-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1 Childcare Application Forms Form and Instruction
30-day Notice_Childcare_03-04-2025.pdf Supplementary Document
60-Day_12-17-2024.pdf Supplementary Document
42 USC 12594.pdf Supplementary Document
Childcare Application SSA_2025.docx Supporting Statement A
Childcare Application Forms Form and Instruction

All Historical Document Collections

202409-3045-003	Extension without change of a currently approved collection	2025-03-04
202112-3045-001 Approved with change	Revision of a currently approved collection	2021-12-03
201809-3045-002 Approved without change	Revision of a currently approved collection	2018-09-19
201508-3045-001 Approved without change	Reinstatement without change of a previously approved collection	2015-08-07
201204-3045-001 Approved with change	New collection (Request for a new OMB Control Number)	2012-04-20