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Confidential Income Statements - Family Day Care Homes

Important Notes

  • Reminder, sponsors have the flexibility concerning the effective date of certification for Program benefits. The date to be used to make this determination may be either the date the parent or guardian signed the Confidential Income Statement or the date on which the sponsor official signs the Confidential Income Statement to certify the eligibility of the participant. This flexibility applies only to eligibility determinations made through the application process of complete applications containing all required information at the time of submission. Sponsors must decide which date they will rely on as the effective date and apply this date to all Confidential Income Statements. However, if the date of parent or guardian signature is not within the month of certification or the immediately preceding month, the effective date must be the date of certification. For more information, refer to the ODE CNP Guidance on Income Eligibility Determinations and Duration – Reissued April 7, 2014
  • Download the fillable Letter to Household and insert the appropriate information in the gray fillable fields before distribution. The Letter to Household must be distributed with the CIS.
  • The CIS heading includes “Child Care Centers/Family Day Care Providers". This is the correct form to use for Family Child Care Providers applying for Tier 1 reimbursement for the provider’s own children and/or Tier 1 income eligibility.
  • The CIS for Family Day Care Tier 2/Family Income is used for families with children in the care of Tier 2 providers who would like to receive Tier 1 reimbursement for daycare children. Section 7 includes a place for the parent/guardian to initial if he/she will consent to allow the provider to collect the CIS form.
  • The CIS “Sponsor Use Only” section is on the first page. Copy both sides of the CIS for distribution.