The Verification for a Child with a Disability, Form 2628, allows child care providers who care for children with a disability to receive a supplemental rate of reimbursement from DHHS. The goal is to encourage child care providers to accept and retain children with special needs, thereby minimizing the expulsion rate of children from child care centers and family child care homes.
- Form must be completed accurately and fully, with the diagnosed disability identified by a licensed Physician, Psychologist, or Social Worker.
- Upon completion, the original form (with original signatures) should be returned to the local DHHS District Office or the local NH Employment Services office.
Authorization is required annually, except for chronic non-changing disabilities.
The Verification for a Child with a Disability (1 page) must be signed by a parent or guardian prior to information being released by Physician, Psychologist, Social Worker or school official. |
