endstream endobj 400 0 obj <>/Metadata 9 0 R/OpenAction 401 0 R/PageLayout/OneColumn/Pages 397 0 R/StructTreeRoot 17 0 R/Type/Catalog>> endobj 401 0 obj <> endobj 402 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 403 0 obj <>stream Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. Complete the top portion of this form and have your child-care provider complete the remainder. Office of Great Start What Would Make Someone Ineligible to be Connected to a Licensed Child Care? Sale, Contract Amendments, Corporate National Crime Information Center's check of the National Sex Offender Registry (NCIC/NSOR). Return the completed form to your specialist in the local DHS office. Find appropriate billing examples for absence hours when using the I-Billing system. Solicitud de Proveedor Exento de Licencia para Desarrollo y Cuidado Infantil (CDC). Sibling (only if the provider and the child do not live together). How much does a Child Care Background Check Cost? Programs for healthy children & families, including immunization, lead poisoning prevention, prenatal smoking cessation, and many others. 3-21), DHS-384, Native American Outreach Services Packet Cover (Rev. 5. Child Care Licensing Bureau forms are available on the website as PDFs and Word Documents. 10-22), MDHHS-5770, Relative Placement Safety Screen (Rev. The form must be signed by one of the following: A physician (M.D. Forms, Independent 3-21), MDHHS-5598, American Indian/Alaska Native Child/Parent Ancestry Verification (Rev. The applicant or the licensee pays for the background check. Form FOC39E Child-Care Verification - Michigan. Visit Michigan's Public Sex Offender Registry (PSOR) to begin a search. The CDC program pays higher reimbursement rates to licensed child care providers with a Reflecting on Quality Level or higher in Great Start to Quality. DHS-1201, IV-D Child Support Services Application/Referral A: If you are found ineligible to be a license exempt provider, you will be notified by the Child Care Background Check unit within the Department of Licensing and Regulatory Affairs (LARA). Is your infant hitting milestones? Directions for how to appeal can be found on theMDHHS - Central Registry page. A child care background check is a both a fingerprint-based and name-based check that will cover the following: If a person lived outside of Michigan within the past 5 years, the following checks will also be conducted for each state or country the person has lived in during the past 5 years: If a person lived in another country and is unable to obtain the equivalent background check components, the person must sign a self-certifying statement that he or she is not ineligible to receive a license, to be an adult member of the household, or to be a child care staff member. Liens, Real Our migrant program works with a number of organizations to provide services for Michigans migrant and seasonal farmworkers. If you do not have Reader installed on your computer, it is available free of charge from Adobe's web site. Information about the Michigan law that requires certain information be made available to a woman who is seeking an abortion at least 24 hours prior to the abortion procedure. Information on child support services for participants and partners. Contact Us Information and Resources- If you are a licensed child care provider, or wish to become one, we encourage you to take advantage of our information and resources to help you provide quality care. 6/22Page 1 of 5 YOUR INCOME, MEDICAL, EDUCATIONAL, AND HEALTH INSURANCE INFORMATION (continued) 48. Certification of School Building Fire Safety Provisions CCL-5043 - Word, Self-Certification of Transportation Provisions for Centers CCL-5044 - PDF Specials, Start This form must be completed and signed by your childcare provider. Phone: 517-335-3704 This Child Care Verification form is used to notify the Court, as well as the opposing party, that child care is in place for the minor child or children. Q: What if I am found ineligible after fingerprinting? Environmental Health Provisions - BCAL-4668, Child Care Center Compliance Record, Part 3. Minutes, Corporate Children's Protective Services Program Download a fillable version of Form FOC39E by clicking the link below or browse more documents and templates provided by the Michigan Circuit Court. Michigan State Police Instructionalvideosare available for free to CDC providers. Universal caseload, or task-based processing, is a different way of handling public assistance cases. But it took a legal challenge and a national campaign to ensure that 17-year-olds were given the same rights as other children in the police station. Agreements, Sale For reimbursement, please go to the Provider Resources section and review the I-Billing instructions and Billing help information. Will, All Operating Agreements, Employment Tags: Child Care Verification, FD-FOC 4036, Michigan Local County, Wayne STATE OF MICHIGAN COUNTY OF WAYNE THIRD JUDICIAL CIRCUIT COURT FAMILY DIVISION CASE NO. Options available for Michigan students that provide unique learning opportunities. Michigan Department of Health and Human Services Templates, Name Agreements, Sale Agreements, LLC Get several related forms for the price of one! Center, Small After reviewing the letter, if you have questions, you may contact 866-990-3227 for assistance. Contact: The additional forms and fees needed to obtain information from other states must be submitted by the applicant in order to be found eligible. Business. Theft, Personal Provider billing information submitted after the deadline, but within seven days of the deadline, will be paid the following week. Fax: 517-763-0280, Website: MDHHS - Central Registry Clearance Requests, Forms: Central Registry Clearance Request - DHS-1929. Planning, Wills You may find approved Level 2 trainings at MiRegistry Statewide Training Calendar. Required for new building/renovations only. Review Package. Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form. A step-by-step guide to registering to be a license exemptprovider for CDC. The steps of the processareoutlined in the the Child Care Background Check Process document. Spanish, Localized Becoming a licensed child care facility requires a background check. !YXNK'^A8i R"3&26HD1l2kY2Nt7yHl1H4gDl--\96F mej% (:0+7,(jZt4MH~:81'*:Y 58A@%h}izFiCkk=rh6! 12-22), MDHHS-5993, American Indian/Alaska Native (AI/AN) Tribal Affiliation Verification - Foster Home (Rev. The pay period number (see Payment Schedule). buss type w 30 amp fuse replacement; Books. MiKidsMatter is part of the Michigan Dept. Please call 866-990-3227 for questions. MI Kids Matter is a resource from the Michigan Department of Education Office of Great Start. LLC, Internet This section explains more about the background check process. Apply for Child Support Online If you are not receiving public assistance, apply for Child Support Services online. Application for Child Care Plan Review (BCHS-FS-13), Child Care Center Notice of Arraignment or Conviction CCL-1486 - PDF, Child Care Center Notice of Arraignment or Conviction CCL-1486 - Word, Child Information Record - CCL-3731 Web Proected, Child Information Record - BCAL 3731-AR (Arabic), Documento de Informacin del Nio Estado de Michigan - BCAL-3731-SP, Written Information Packet Documentation CCL-4340 - PDF, Written Information Packet Documentation CCL-4340 - Word, Change of Use Space Request for School-Age Programs Located in Schools CCL-4342 - PDF, Change of Use Space Request for School-Age Programs Located in Schools CCL-4342 - Word, Lead Hazard Risk Assessment Summary CCL-4344 - PDF, Lead Hazard Risk Assessment Summary CCL-4344 - Word, No Change in Building Construction Declaration CCL-2129 - PDF, No Change in Building Construction Declaration CCL-2129 - Word, Infant/Toddler Primary Caregiver Documentation CCL-4557 - PDF, Infant/Toddler Primary Caregiver Documentation CCL-4557 - Word, Center Fire and Tornado Drill Record - CCL-4593 - PDF, Center Fire and Tornado Drill Record - CCL-4593 - Word, Staffing Plan: Child Care Center CCL-5001 - PDF Contractors, Confidentiality State(s) Child Abuse and Neglect Registry Check. To babyproof your home? ). Child Care License Designee CCL-5003 - Word, Certification of School Building Fire Safety Provisions CCL-5043 - PDF A provider may begin taking training to count towards Level 2 after completing the Great Start to Quality Orientation (GSTQ Level 1). Review Package, All forms provided by US Legal Forms, the nations leading legal forms Get Form Verification - Pension : Live In Attendant Self Certification Affidavit: Verification - Employment : Verification - Alimony: Verification - Child Care Expense : Verification - Annuity: Verification - Child Support : Verification - Disability for all other Sec. "The Forms Professionals Trust . Upgrade and All information is provided in good faith, however, we make no representation or warranty of any kind regarding its accuracy, validity, reliability, or completeness. Finish redacting the form. Information on prenatal health and preparing for your baby's arrival. Birth, Death, Marriage and Divorce Records. Child Care Verification Form (PDF) , Instructions (PDF) , - For work-related child care expenses Request for a Review (PDF) - To request a review of child support File Access Request Form (PDF) - To access the documents in your Friend of the Court file Parenting Time Violation (PDF) - To report a violation or Parenting Time Denial Apply to become a license exempt related or unrelated child care provider. Child Care Call Center Hours: Beginning Monday August 16, 2021, CDC will have new call center hours. Visit your local MDHHS Officefor forms or applications not available online. FOC 39e (3/09) CHILD-CARE VERIFICATION. Every template is drafted and updated by state-certified lawyers. What is the Process for Another State to Obtain Michigan's Registry Checks? The parent will submit the form to MDHHS. The Word documents are fillable and are intended for electronic completion. 608 W. Allegan Out-of-state entities requesting Central Registry clearances for the reasons outlined in Section IV. If you have child care expenses you must attach the "Child Care Verification" form. A: If you wish to be licensed as a child care center, group child care home orfamily child care home, call the Child Care Licensing Bureau (CCLB) toll free at 1-866-685-0006 or visit: www.michigan.gov/michildcare. Change, Waiver Sales, Landlord Corporations, 50% off To begin, complete a CDC License Exempt ProviderApplication, which can also be found below or call 1-866-990-3227. Transportation Provisions - BCAL-1891, Child Care Center Compliance Record, Part 5. 422 0 obj <>/Filter/FlateDecode/ID[<0F81578DBFE6954F99F1EC432DAA92DB><7E632B1BD3414B40A955C0CD1B8CF54C>]/Index[399 49]/Info 398 0 R/Length 104/Prev 73169/Root 400 0 R/Size 448/Type/XRef/W[1 2 1]>>stream Order Specials, Start CDC limits on provider billing per pay period. Playground Inspection Certification Summary CCL-5047 Word, Incident Report CCL-4605 - PDF For Orientation, select "Learn about Orientation". The web Browser you are currently using is unsupported, and some features of this site may not work as intended. This is a legal form that was released by the Michigan Circuit Court - a government authority operating within Michigan. Upgrade and Save: This form is part of a package. Additionally, children attending programs at the Reflecting on Quality Level through Demonstrating Quality Level will not have a family contribution amount deducted from the payment to the provider. The DHS-4575, Child Development and Care (CDC) Proof of Family Preservation Need, must be used to document the family preservation child care need. Agreements, Bill Information on American Indian Services, Employment and Training. The Word documents are fillable and are intended for electronic completion. Adult Member of Household (Family and Group), Volunteers with Unsupervised Access to children in care (Family, Group and Center), An individual who has unsupervised access to children who are cared for or supervised by a family child care home, group child care home, or child care center. Contractors, Confidentiality Amendments, Corporate Agreements, Letter Forms, Independent Incorporation services, Living Mi Kids Matter is your place to find what you need to give your child their best chance at health, happiness, and success later in life. Agreements, Corporate For the Quality Rating Process, select "Learn about Participating". endstream endobj 404 0 obj <>stream When you need a legal form, don't accept anything less of Directors, Bylaws Resources for educator certification, recognition programs, evaluation, and workforce research. License Exempt ProviderFBI Fingerprint Process. information about the Department's public safety programs. Includes information on program rules and requirements that you are required to follow. & Resolutions, Corporate Steps from enrollment to billing for license exempt providers. 235 South Grand Ave., Suite 510 Verificacion de Antecedentes de Cuidado Infantil del Estado de Michigan Consentimiento y Revalacion. FRIEND OF THE COURT INCOME WORKSHEET FOR NEW CASES FOR CHILD SUPPORT, CUSTODY, PARENTING TIME AND MEDICAL . Information on communicable & chronic diseases. Reducing Barriers to Licensure for Military Families, Corporations, Securities & Commercial Licensing, Find / Verify a Licensed Professional or Business, Make a Complaint About a Licensed Professional or Business, Look Up Underground Storage Tank Information, Access the Online Liquor Ordering (OLO) System, Regulated Products, Professions, & Businesses Activities, Resources for Veterans & Military Families, https://dev.michigan.local/som/json?sc_device=json, Playground Inspection Certification Summary CCL-5047 Word, Go to An Online Resource for Skilled Immigrants, Medical Marijuana Program (MMMP) Patients & Caregivers, Learn About CRA Rules, Laws & Regulations, Find / Verify a CRA Licensed Professional or Business, Make a Complaint About a CRA Licensed Professional or Business, Track Marijuana Inventory - Statewide Marijuana Monitoring System (Metrc), Find Panel, Public Hearing & Workgroup Information, Find a Disciplinary Action Report or Document, Learn About CCL Rules, Laws & Regulations, Find / Verify a CCL Licensed Professional or Business, Make a Complaint About a CCL Licensed Professional or Business, Apply for / Renew a BCC License or Permit, Find / Verify a BCC Licensed Professional or Business, Make a Complaint About a BCC Licensed Professional or Business, Learn About Examinations & Continuing Education, Find / Verify a BCHS Licensed Professional or Business, Make a Complaint About a BCHS Licensed Professional or Business, Go to Corporations, Securities & Commercial Licensing, Find / Verify a CSCL Licensed Professional or Business, Make a Complaint About a CSCL Licensed Professional or Business, Contact the Michigan Liquor Control Commission, Local Government & Law Enforcement Resources, Go to Michigan Office of Administrative Hearings and Rules, Administrative Hearings Frequently Asked Questions, Request to Attend a Hearing (for Media Professionals), Go to Michigan Indigent Defense Commission, Learn About Continuing Legal Education (CLE), Make a Complaint or Inquiry About a Utility Provider, Compare Natural Gas Utilities Options (MI Gas Choice), Submit an Underground Utilities Locate Request (MISS DIG 811), Learn About Natural Gas & Pipeline Providers, Learn About Rules of Practice and Procedure, Find / Verify a BPL Licensed Professional or Business, Make a Complaint About a BPL Licensed Professional or Business, Michigan Automated Prescription System (MAPS), Find / Verify a UCC Licensed Professional or Business, Make a Complaint About a UCC Licensed Professional or Business, Go to Apply for / Renew a License or Permit, Go to Find / Verify a Licensed Professional or Business, Go to Make a Complaint About a Licensed Professional or Business, Go to Look Up Underground Storage Tank Information, Go to Look Up a Controlled Substance (MAPS), Go to Access the Online Liquor Ordering (OLO) System, Go to Look Up a Disciplinary Action Report, Go to Submit a Request for Information (FOIA), Go to Regulated Products, Professions, & Businesses Activities, Go to Requesting Information from LARA (FOIA), Go to Resources for Veterans & Military Families, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 - Spanish, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 - Arabic, Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591 - PDF, Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591 - Word, Staffing Plan: Child Care Center CCL-5001 - PDF, Staffing Plan: Child Care Center CCL-5001 - Word, Staffing Plan: Child Care Center CCL-5001 Excel, Child Care License Designee CCL-5003 - PDF, Child Care License Designee CCL-5003 - Word, Certification of School Building Fire Safety Provisions CCL-5043 - PDF, Certification of School Building Fire Safety Provisions CCL-5043 - Word, Self-Certification of Transportation Provisions for Centers CCL-5044 - PDF, Self-Certification of Transportation Provisions for Centers CCL-5044 - Word, Volunteer Certification for Field Trip Transportation CCL-5046 - PDF, Volunteer Certification for Field Trip Transportation CCL-5046 - Word, Playground Inspection Certification Summary CCL-5047 - PDF, Family and Group Child Care Home Compliance Record - BCAL-4601, Preparing for Your License Renewal Fire Safety Inspection - BCAL-5048, Child Care Center Compliance Record, Part 1.