Eligibility and Forms
Helpful Forms for Parents
- Child Care Application - To apply for child care assistance
- Monthly Work Hour Verification - To verify hours previously worked
- Wage Verification Form - Verify wages and hours until check stubs are available
- Self-Employment Form - To report income and expensees for self-employed individuals
- Appeal for Termination or Denial of Child Care Assistance - Form to request an appeal on a decision made on a child care case
Formularios Útiles para Padres
- Solicitud de Cuidado Infantil - Para solicitar asistencia de cuidado infantil
- Trabajo por Cuenta Propia Forma - Para reportar los ingresos y gastos de los trabajadores autónomos
- Petición para Apelacion - Use este formulario solo si quiere presenter una apelación (una petición para una audiencia)
Due to IDHS form updates and the barcoding system, we are unable to offer other forms for online download. If you need a form and do not see it here, please pick one up in person at our office during regular business hours.
For Providers
- Telephone Billing Information for Providers - Information about billing for child care by phone
- Telephone Billing Agreement - Form used to sign up for billing for child care by phone
- Illinois Debit Card Facts - information about receiving payments for child care to a debit card
- Illinois Debit Card Payment Option Form - request to receive payments for child care to a debit card
- W-9 Form (English) - IRS form required to receive payment
- W-9 Form (Espanol) - Formulario IRS requiere para recibir el pago
- Child Care Rate Certification Form - If you are a licensed home, child care center or a license-exempt child care center, you must complete this form to record your child care rates.
- Child Care Assistance Program Payment Rates - The current payment rates for all provider types.
- Health and Safety Training Checklist - A list of required trainings for license-exempt child care centers and license-exempt non-relative home providers.
- DCFS License Exemption for School-aged Programs - If you are a license-exempt child care center, you must have a current license exemption letter from DCFS to be eligible to receive child care payments with the assistance program.
