Self-declaration Process 620-01-30-01

(Revised 10/1/16 ML #3480)

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  1. The applicant completes SFN 865.
  1. Applicant obtains certification in CPR and First Aid from an approved source
  1. Applicant returns completed SFN 865, SFN 508 for emergency designee and household members, copies of CPR and First Aid certification, and copies of pet vaccinations, if applicable, to their local authorized agent with the application fee.
  1. Authorized agent will work with regional office and CBCU to complete background check.
  1. Authorized agent completes pre-approval visit to the location where care is to be provided. Authorized agent documents visit on SFN 1595.
  1. Authorized agent submits the SFN 865, SFN 508, SFN 1595, copies of required training certificate, copies of pet vaccinations, if applicable, and copies of CPR and First Aid certification to the regional office.
  1. Authorized agent shall keep copies of these documents for their files.
  1. Regional office approves or denies application.
  1. If approved, regional office sends self-declaration certificate to authorized agent, who keeps copy and forwards original to provider.
  1. There shall be only one self-declaration per residence. In other words, two self-declared individuals cannot provide child care at the same residence/address.
  1. If there are new household members twelve years of age and older after the application, the provider must submit an SFN 508 for that household member.