Child Care: Forms

PASS I

• Child Care Assistance Program Rate Schedule (January 2023 - Current)
• Child Care Family Income and Contribution Schedule (January 2023 - Current)
• CC02 - Manual Authorization Request for PASS I
• CC03 - Parent Responsibility Agreement – PASS I
• PASS I Child Care Assistance Brochure

PASS II & III

• CC29 - Termination of Child Care Services​
• CC46 - Child Care Assistance Program & Alaska Inclusive Child Care Program Request for Hearing
• CC24 - Health Status Report
• CC36 - Employment Statement
• CC37 - Family Report of Change
• CC38 - Monthly Tip Ledger
• CC08 - Child Care Assistance Application 
• CC39 - Self-Employment Income / Deduction Worksheet
• PASS II & PASS III Child Care Assistance Brochure

• Alaska Employer Registration Form for Daycare Services form TREG
• Alaska New Hire Reporting Form 04-1050
• CC89 - Plan of Care for a Child with Special Needs
• Example Children Attendance
• CC 52 - Application for Provisional Child Care License
• CC100 - Parent List
• CC103 - Firearms and Ammunition Storage
• CC105 - Animal on Child Care Facility Premises
• CC25 - General Variance Application
• CC47 - Child Emergency Information (Please contact your licensing specialist)
• 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
• 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
• 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
• Introduction to the Provisional Child Care Licensing Process
• Sample Typical Daily Schedule of Activities
• Child Care Licensing Brochure
• Child Care Program Office (CCPO) Brochure
• CC258 - Associate Administrator Designation and Qualification
• CC259 - Associate Administrator Reference

• Alaska Employer Registration Form for Daycare Services form TREG
• Additional Information You Need to Know about In-home Care
• Approved Relative Child Care Provider Application Coversheet
• Approved Relative Child Care Provider Renewal Application Coversheet
• CC10 - Approved Child Care Provider Disaster Preparedness and Emergency Evacuation Plan
• CC103 - Firearms and Ammunition Storage
• CC11 - Approved Relative Child Care Provider Health and Safety Requirements
• CC18 - In-home Child Care Parent / Caregiver Agreement
• CC27 - Health and Safety Requirements for In-home Child Care
• CC40 - In-home Child Care Application
• CC42 - Approved Relative Child Care Provider Application
• CC47 - Child Emergency Information (Please contact your licensing specialist)
• CC81 - Approved Relative Health and Safety Inspection Checklist
• CC82 - Approved Relative Child Care Provider Renewal Application
• CC83 - Approved Relative Provider and In-home Caregiver Health and Safety Training Checklist
• CC86 - In-home Child Care Renewal Application
• In-home Child Care Application Coversheet
• In-home Child Care Renewal Application Coversheet

• CC29 - Termination of Child Care Services​
• CC46 - Child Care Assistance Program & Alaska Inclusive Child Care Program Request for Hearing
• Child Care Assistance Program Rate Schedule (January 2023 Current)
• Child Care Family Income and Contribution Schedule (January 2023 - Current)
• Alaska Employer Registration Form for Daycare Services form TREG
• Alaska New Hire Reporting Form 04-1050
• CC12 - Child Care Provider Rates and Responsibilities
• CC41 - Licensed Provider Child Care Assistance Application
• CC43 - Child Care Provider Report of Change
• CC78 - Request for Payment
• CC79 - Amended Request for Payment
• CC84 - Certified / Accredited Provider Child Care Assistance
• CC85 - Children’s Daily Attendance
• CC89 - Plan of Care for a Child with Special Needs
• Certified / Accredited Provider Child Care Assistance Application Coversheet
• Example Children Attendance
• Licensed Provider Child Care Assistance Application Coversheet

• CC33 - Child Care Grant Request For Good Cause Waiver Form
• CC102 - Child Care Grant Request to Apply Funds to a Past Purchase
• 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
• CC35 - Child Care Grant Request For Administrative Review
• Child Care Grant Rate Schedule
• CC61 - Parents’ Guide to Licensed Care (Teddy Bear Letter)

CC46 - Child Care Assistance Program & Alaska Inclusive Child Care Program Request for Hearing

CC89 - Plan of Care for a Child with Special Needs

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

• Form I-9: Employment Eligibility Verification
• Form SS-4: Application for Employer Identification Number
• Form W-2: Wage and Tax Statement
• Form W-4: Employee’s Withholding Allowance Certificate
• Substitute W-9