Division for Children, Youth and Families,

Child Development Bureau

The Provider Verification Form 2530 (2 pages) is required to verify child care provider requirements and to ensure children are "linked" (which establishes that the provider is caring for the child).  The form includes instructions to assist parents or 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 must be submitted for all children that are eligible for the Child Care and Development Fund scholarship. 
• Form must be completed accurately and fully. 
• Form must have original parent and provider signatures (no photocopies will be accepted).

• Completed Forms should be returned to the local DHHS District Office or the local NH Employment Services office.