The Child Care Payment Request Invoice Form 2500 is an invoice form submitted by child care providers to receive payment for providing care to children whose parents qualify for the Child Care and Development Fund scholarship. The form includes detailed instruction to assist providers with completion of the form. The instructions refer to the Non-Carbon Reproduction (NCR) form which indicates how to distribute the various colored copies. When printing this form from the DHHS Website, both the parent and the provider should make and keep a photocopy.
Form Claims on or after 6/29/09: Form 2500
- Form must be completed accurately and fully.
- Form submitted must have original parent and provider signatures (no photocopies will be accepted)
- One form per child, per week (Monday - Sunday) is to be submitted to:
NH DHHS
ATTN: Bureau of Data Management
PO Box 2000
Concord, NH 03302-2000
In order to bill for a particular child, child care providers must be "linked" to the child through the Child Care Provider Verification, Form 2530 (which establishes that the provider is caring for the child) and must have been enrolled and registered as a provider with DHHS. |
