Child Care Assistance Forms

Please read all instructions carefully. To help us serve you better, please make sure forms are filled out completely and legibly. Attach all necessary documentation (i.e. check stubs, school schedule) and keep a copy of all forms for your records. Most forms are available in English and Spanish.

Spanish-language forms are available in the sidebar on the right.

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Child Care Application Form

• The Child Care Application is used when initially applying for child care or when a previous child care case is no longer active.
• Application checklist for parents
• Application checklist for providers (coming soon)

Redetermination Form

• This form is used to recertify current eligibility and must be submitted within 30-days of the eligibility end date or to update a case based on significant changes.

Wage Verification Form

• This form is used to verify income for families paid in cash or have just begun a new job and are waiting for two consecutive check stubs.

Request for Child Care Provider Change Form

Change of Information Form

IDHS Self Employment Record Form

• This form is used to record monthly business expenses and income by those who are self-employed.

Family Size Verification Form

• This form is used to verify family size when someone other than an immediate family member is being included in the family size.

W-9 Form

• This form is submitted to the Illinois Department of Human Services Comptroller office for processing. The provider must be approved by the State of Illinois to be compensated for services.