Childcare Application Forms

Childcare Benefit Forms

OMB: 3045-0142

IC ID: 217805

Information Collection (IC) Details

View Information Collection (IC)

Childcare Application Forms
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Provider Application PROVIDER APPLICATION_2025.docx www.nationalservice.gov Yes Yes Fillable Fileable Signable
Form and Instruction 2 Member Application MEMBER APPLICATION_2025.docx www.nationalservice.gov Yes Yes Fillable Fileable Signable
Form and Instruction 3 Childcare Attendance Sheet Attendance Sheet Invoice.pdf www.nationalservice.gov Yes Yes Fillable Fileable Signable
Form and Instruction 4 Statement of Work Activity STATEMENT OF WORK ACTIVITY.docx www.nationalservice.gov Yes Yes Fillable Fileable Signable
Form and Instruction 5 Member Update Form MEMBER UPDATE FORM.docx www.nationalservice.gov Yes Yes Fillable Fileable Signable
Form and Instruction 6 Childcare Payment Authorization Payment Authorization.docx www.americorps.gov Yes Yes Fillable Fileable Signable
Form and Instruction 7 AmeriCorps Unlicensed Provider Affidavit Unlicensed Provider Affidavit.docx www.americorps.gov Yes Yes Fillable Fileable Signable
Form and Instruction 8 Program Certification of Active Service Certification of Active Service.docx www.americorps.gov Yes Yes Fillable Fileable Signable

Community and Social Services Community and Regional Development

CNCS-06-CPO-ACB-AmeriCorps Child Care Benefit System  84 FR 46002

1,040 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,040 0 0 -1,060 0 2,100
Annual IC Time Burden (Hours) 520 0 0 -530 0 1,050
Annual IC Cost Burden (Dollars) 11,638 0 0 -11,861 0 23,499

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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