929.01 Required Provider Enrollment Documentation SR 17-12 Dated 07/17 (FAM-A)

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Child care provider enrollment is processed through the Child Development Bureau.

All required enrollment forms are available in the Child Care Enrollment packet and on the DHHS website https://www.dhhs.nh.gov/dcyf/cdb/forms.htm and must be submitted to:

DHHS/DCYF/Child Development Bureau

Attn: Provider Enrollment Specialist

129 Pleasant Street

Concord, NH 03301

 

Licensed Providers must complete and submit the following from the Child Care Provider Enrollment packet:

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DCYF Form 1860, Child Care Provider Agreement;

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DHHS Form AW-9, Alternate W-9 Form-CIS;

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DCYF Form 1862, Child Care Provider Enrollment Form; and submit

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a copy of the current New Hampshire child care license from the Office of Program Support, Child Care Licensing Unit; and

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health and safety training documentation, first aid certification for infant and child, pediatric cardiopulmonary resuscitation (CPR) certification are required to be documented in the employee’s file.

 

License-Exempt Providers must complete and submit the Child Care Provider Enrollment packet including the following:

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DCYF Form 1860, Child Care Provider Agreement;

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DHHS Form AW-9, Alternate W-9 Form-CIS;

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DCYF Form 1862, Child Care Provider Enrollment Form;

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DCYF Form 2503, DCYF Central Registry Name Search Authorization

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DCYF Form 2505, Background Check Authorization;

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DCYF Form DSSP372, New Hampshire Health and Human Services Criminal History Record Information and Authorization, License Exempt Child Care Form NH RSA 107-E:4, including results of fingerprinting;

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health and safety training documentation, first aid certification for infant and child, pediatric cardiopulmonary resuscitation (CPR) certification are required to be documented in the New Hampshire Professional Registry.

 

References: He-C 6914.06 (c), RSA 161:2,XII, RSA 167:83,II(o), RSA 167:83,III(g), RSA 170-E:3-a, RSA 170-E:4,II, RSA 170-E:7, RSA 170-E:12, 45 CFR 98.40