Child Care Self-declaration 620-01-30

(Revised 10/1/16 ML #3480)

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Self-declaration packets shall be made available at the county agency and should include the following:

 

  1. N.D.A.C. §75-03-07.1
  1. N.D.C.C ch. 50-11.1
  1. SFN 865 -- Application for Self-declaration
  1. SFN 845 Child Information Sheet
  1. SFN 847 Parent’s Statement on the Health of a Child
  1. SFN 16038 Certificate of Immunization
  1. Cover Letter/Instructions from the authorized agent, including instructions for CPR and First Aid certification
  1. IRS Form W-9 Request for Taxpayer ID # & Certification
  1. SFN 1595 Self-Declaration Provider Review
  1. SFN 508 Authorization for Background Check
  1. SFN 517 Child Care Evacuation Disaster Plan
  1. SFN 1426 Child Care Record
  1. Instruction and forms for fingerprint background check
  1. Basic Child Care Information
  1. Annual Training Form
  1. CCAP brochure
  1. CACFP Information
  1. CCA brochure
  1. Sample Policy Statement
  1. Brochures:

Child and Adult Care Food Program (CACFP)

Bright and Early brochure

Growing Future brochure

Head Start and Early Head Start brochure

Financial Assistance flyer

  1. Other appropriate brochures or information