941.01 Required Verification for a Child with a Disability SR 14-16, 04/14 (FAM-A)

To be eligible for the disability differential payment for a child aged 12 and under, the disability must be verified on DCYF Form 2628, Verification for a Child with a Disability.

If the individual requests child care services for a child age 13 or older, require a signed and dated statement from the child's attending physician, physician's assistant, advance practice registered nurse or licensed mental health professional. The statement must describe the child’s condition and specify the need for supervision.

Authorize the disability differential according to the date the licensed professional signed DCYF Form 2628, Verification for a Child with a Disability, or signed the statement if the child is age 13 or over.

The disability differential payment becomes effective the Monday following the authorization date.

Verification must be provided annually. However, if DCYF Form 2628 describes the child’s disabling condition as permanent, no subsequent verification is needed.

References: He-C 6910.08(g) and (h), RSA 167:83,II(c) and (o), 45 CFR 98.20, 45 CFR 98.44