​​​​Child Care Services Forms

Applicable to both Families and Providers

• CC29 - Termination of Child Care Services​
• CC46 - Child Care Assistance Program & Alaska Inclusive Child Care Program Request for Hearing
• Child Care Program Office (CCPO) Brochure
• PASS I Child Care Assistance Brochure
• PASS II & PASS III Child Care Assistance Brochure
• Child Care Assistance Program Rate Schedule (January 2023 - Current)
  
• Child Care Family Income and Contribution Schedule (Nov. 2019 - December 2022) 
• Child Care Family Income and Contribution Schedule (January 2023 - Current)
  

Family Application and Change Forms

• CC08 - Child Care Assistance Application 
• CC24 - Health Status Report
• CC36 - Employment Statement
• CC37 - Family Report of Change
• CC38 - Monthly Tip Ledger
• CC39 - Self-Employment Income / Deduction Worksheet

Provider Forms

• CC10 - Approved Child Care Provider Disaster Preparedness and Emergency Evacuation Plan
• CC11 - Approved Relative Child Care Provider Health and Safety Requirements
• CC12 - Child Care Provider Rates And Responsibilities
• CC18 - In-home Child Care Parent / Caregiver Agreement
• CC25 - General Variance Application
  
• CC27 - Health and Safety Requirements for In-home Child Care
• CC40 - In-home Child Care Application
• In-home Child Care Application Coversheet
• Licensed Provider Child Care Assistance Application Coversheet
• CC41 - Licensed Provider Child Care Assistance Application
• Approved Relative Provider Application Coversheet
• CC42 - Approved Relative Child Care Provider Application
• CC43 - Child Care Provider Report of Change
• CC47 - Child Emergency Information (Please contact your licensing specialist)
  
• CC63 - Emergency Evacuation Drill Report
• CC72 - Permission to Operate a Child Care Business
• CC78 - Request for Payment
• CC79 - Amended Request for Payment
  
• CC80 - Report of Family Non-Payment
  
• CC81 - Approved Relative Health and Safety Inspection Checklist
• Approved Relative Child Care Provider Renewal Application Coversheet
• CC82 - Approved Relative Child Care Provider Renewal Application
• CC83 - Approved Relative Provider and In-home Caregiver Health and Safety Training Checklist
• CC84 - Certified / Accredited Provider Child Care Assistance Application
• CC85 - Children’s Daily Attendance
• In-home Child Care Renewal Application Coversheet
• CC86 - In-home Child Care Renewal Application
  
• CC87 - Typical Daily Schedule of Activities
• Sample Typical Daily Schedule of Activities
• CC88 - In-home Child Care Health and Safety Inspection Checklist
  
• CC89 - Plan of Care for a Child with Special Needs
• Substitute W-9

Case Manager

• CC02 - Manual Authorization Request for PASS I
• CC03 - Parent Responsibility Agreement – PASS I
  

CCAP Application for Licensed Child Care Providers - CCAP Application Forms

• Licensed Provider Child Care Assistance Coversheet
  
• CC41 - Licensed Provider Child Care Assistance Application
• CC12 - Child Care Provider Rates and Responsibilities
• Substitute W-9

U.S. Department of Defense / Nationally Accredited Providers - CCAP Application Form

• Certified / Accredited Provider Child Care Assistance Application Coversheet
  
• CC84 - Certified / Accredited Provider Child Care Assistance Application
  
• CC12 - Child Care Provider Rates and Responsibilities
• Substitute W-9
  

Approved Relative Application Forms

• Approved Relative Child Care Provider Application Coversheet
• CC42 - Approved Relative Child Care Provider Application
• CC10 - Approved Child Care Provider Disaster Preparedness and Emergency Evacuation Plan
• CC11 - Approved Relative Child Care Provider Health and Safety Requirements
• CC12 - Child Care Provider Rates and Responsibilities
• CC72 - Permission to Operate a Child Care Business
• Substitute W-9

Approved Relative Renewal Application Forms

• Approved Relative Child Care Provider Renewal Application Coversheet
• CC82 - Approved Relative Child Care Provider Renewal Application

In-home Child Care Application Forms

• In-home Child Care Application Coversheet
• CC40 - In-home Child Care Application
• CC10 - Approved Child Care Provider Disaster Preparedness and Emergency Evacuation Plan
• CC18 - In-home Child Care Parent / Caregiver Agreement
• CC27 - Health and Safety Requirements for In-home Child Care
• Alaska New Hire Reporting Form 04-1050
• Alaska Employer Registration Form for Daycare Services form TREG
• Form SS-4: Application for Employer Identification Number
• Form I-9: Employment Eligibility Verification
• Form W-2: Wage and Tax Statement
  
• Form W-4: Employee’s Withholding Allowance Certificate
• Additional Information You Need to Know about In-home Care
  

In-home Child Care Renewal Application Forms

• In-home Child Care Renewal Application Coversheet
• CC86 - In-home Child Care Renewal Application

Child Care Grant Program Forms

• CC14 - Child Care Grant Report Form
• CC15 - CCG Reimbursement Request
  
• CC30 - Child Care Grant Application
• CC31 - Child Care Grant Reimbursement For Staff Salaries and Benefits or Substitute Care
• CC32 - Child Care Grant Request to Save Funds – Apply Past Funds
• CC33 - Child Care Grant Request For Good Cause Waiver Form
• CC35 - Child Care Grant Request For Administrative Review
• CC102 - Child Care Grant Request to Apply Funds to a Past Purchase
  
• Child Care Grant Brochure
• Child Care Grant Rate Schedule

Alaska Inclusive Child Care Program Forms

• CC46 - Child Care Assistance Program & Alaska Inclusive Child Care Program Request for Hearing
• CC48 - Application for Alaska Inclusive Child Care
• CC49 - Special Needs Document
• CC50 - Child Care Provider Inclusion Plan
• Alaska Inclusive Child Care Program (Alaska IN!) Brochure

Child Care Licensing Program Forms

• Child Care Licensing Brochure
• CC47 - Child Emergency Information (Please contact your licensing specialist)
  
• CC 52 - Application for Provisional Child Care License
  
• CC53 - Request for Nighttime Care Specialization
• CC54 - Request for Specialized Program Activity
• CC55 - Governing Body Information
• CC56 - Administrator Designation and Qualification Form
• CC57 - Child Care Facility-Administrator Reference
• CC58 - Child Care Associate Designation and Qualification Form
• CC59 - Child Care Center- Child Care Associate Reference
• CC60 - Child Care Facility Personnel Policies Checklist
• CC61 - Parents’ Guide to Licensed Care (Teddy Bear Letter)
• CC62 - First Aid and Disaster Kit Checklist
• CC63 - Emergency Evacuation Drill Report
• CC65 - Notification of a Facility Emergency
  
• CC67 - Get Out Alive! Evacuation Plan
• CC71 - Child Care Facility Staffing Plan
• CC72 - Permission to Operate a Child Care Business
• CC73 - Plan for Shared Use of a Child Care Facility
• CC74 - Plan for Alternate Outdoor Recreation Space
• CC75 - Request for Exemption
• CC77 - Child Care Facility Parent Policies Checklist
• CC80 - Report of Family Non-Payment
  
• CC89 - Plan of Care for a Child with Special Needs
• CC91 - Child Injury / Illness / Incident Report
  
• CC92 - Facility Schedule Reporting Form
  
• CC93 - Plant Safety Plan
  
• CC94 - Application for Biennial Child Care License
  
• CC95 - Report of Change
• CC100 - Parent List
• CC103 - Firearms and Ammunition Storage
• CC105 - Animal on Child Care Facility Premises
• Introduction to the Provisional Child Care Licensing Process
  
• Example Children Attendance