929.01 Required Verification SR 14-34, 11/14 (FAM-A)

*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 http://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:

• DCYF Form 2632, Child Care and Development Fund Scholarship, Child Care Provider Agreement: Licensed Child Care;

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

• DCYF Form 2620, Child Care Provider Enrollment Form;

• DCYF Form 2530, Child Care Provider Verification; and submit

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

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

• DCYF Form 2631, Child Care and Development Fund Scholarship, Child Care Provider Agreement: License-Exempt Child Care;

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

• DCYF Form 2620, Child Care Provider Enrollment Form;

• DCYF Form 2601, Background Check Authorization;

• DCYF Form 2602, 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;

• DCYF Form 2530, Child Care Provider Verification

References: He-C 6910.20(b)(7)(8)(c)-(e), 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