929.01 Required Provider Enrollment Documentation (FAM)

SR 20-23 Dated 08/20

Previous Policy

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Child care provider enrollment is processed through the Bureau of Child Development and Head Start Collaboration (BCDHSC). .

All required enrollment forms are available in the Child Care Enrollment packet and on the DHHS website https://www.dhhs.nh.gov/dcyf/cdb/forms.htmand must be submitted to:

DHHS/DEHS/Bureau of Child Development and Head Start Collaboration

Attn: Provider Enrollment Specialist

129 Pleasant Street

Concord, NH 03301

 

Licensed Child Care Providers must complete and submit the following from the Child Care Provider Enrollment packet:

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DEHS/BCDHSC Form 1860, Child Care Provider Agreement;

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DHHS Form AW-9, Alternate W-9 Form-CIS;

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DEHS/BCDHSC Form 1862, Child Care Provider Enrollment Form; and submit

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a copy of the current New Hampshire child care license from the Office of Program Support, Child Care Licensing Unit; and

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health and safety training documentation, first aid certification for infant and child, pediatric cardiopulmonary resuscitation (CPR) certification are required to be documented in the employee’s file.

 

License-Exempt Child Care Providers must complete and submit the Child Care Provider Enrollment packet including the following:

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DEHS/BCDHSC Form 1860, Child Care Provider Agreement;

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DHHS Form AW-9, Alternate W-9 Form-CIS;

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DEHS/BCDHSC Form 1862, Child Care Provider Enrollment Form;

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DEHS/BCDHSC Form 2503, DCYF Central Registry Name Search Authorization

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DEHS/BCDHSC Form 2505, Background Check Authorization;

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DEHS/BCDHSC Form DSSP372, New Hampshire Health and Human Services Criminal History Record Information and Authorization, License Exempt Child Care Form NH RSA 107-E:4, including results of fingerprinting;

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health and safety training documentation, first aid certification for infant and child, pediatric cardiopulmonary resuscitation (CPR) certification are required to be documented in the New Hampshire Professional Registry;

Complete an initial DHHS monitoring visit conducted by DHHS Child Care Licensing Unit.

 

References: He-C 6914.04 (b)(1)-(3), He-C 6914.06 (c), RSA 161:2,XII, RSA 167:83,II(o), RSA 167:83,III(g), RSA 170-E:3-a, RSA 170-E:4,II, RSA 170-E:7, RSA 170-E:12, 45 CFR 98.40