941.01 Required Verification for a Child with a Disability SR 15-23, 09/15 (FAM-A)

To be eligible for the *differential payment for a child experiencing a significant special need*, the *significant special need must be verified on DCYF Form *2690, Verification for a Child Experiencing Significant Special Needs, for all children experiencing a significant special need for whom additional funds are required to make accommodations or adaptations, including children age 13-17.

*

The DCYF Form 2690, Verification for a Child Experiencing Significant Special Needs, is considered complete when the following items on the form are indicated:

Section I, the Child Care Provider has:

• Checked the certification box indicating the need for funds;

• Indicated the planned accommodation(s) or adaptation(s);

• Signed the form; and

• Dated the form.

Section II, the Licensed Professional has:

• Checked the appropriate certification box;

• Signed the form; and

• Dated the form.

Section III, the Parent/Guardian has:

• Signed the form; and

• Dated the form.

Authorize the *differential payment for a child experiencing a significant special need according to the date the licensed professional signed DCYF Form 2690, Verification for a Child *Experiencing Significant Special Needs*.

The *differential payment for a child experiencing a significant special need becomes effective the Monday following the authorization date.

*If the need for funds to support the child continues following the initial verification, a new DCYF Form 2690 must be provided at the end of the expected duration, annually, or when the child changes child care providers. However, if DCYF Form 2690 describes the child’s *significant special need 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