Child Care Application Form
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.
In order to expedite processing of your application it is important that you read all documents in detail. It is also important that you submit a complete application that includes the required supporting documentation.* Please allow ten business days from the day of receipt for your application to be reviewed.
If you need assistance in completing the application or other documents please contact us for help.
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The Child Care Application is used when initially applying for child care or when a previous child care case is no longer active.
W-9 Form
A W-9 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.
Wage Verification Form
A Wage Verification Form is used to verify a parent’s employment. A Wage verification form should be completed by their employee and returned to our office along with any necessary documentation.
Telephone Billing Agreement
A Telephone Billing agreement allows providers to enter their Childcare payment through the Child Care Telephone Billing System
Debit Card Form
Providers can receive their Childcare Assistance Payments through an Illinois Debit Mastercard
*Please note that state authorized databases will be used to clarify information submitted to our offices. These databases include, but are not limited to, TANF, Child Support Enforcement, Wage Verification, birth records, Social Security Administration, employment security, Department of Labor, and Chicago Public Schools.