Free Oregon Dhs Child Care Provider PDF Template

Free Oregon Dhs Child Care Provider PDF Template

The Oregon DHS Child Care Provider Listing Form is a crucial document designed for individuals providing child care services in Oregon. This form helps determine whether a provider needs to be licensed or can operate under license-exempt status, depending on their relationship to the children in their care. Completing this form accurately is essential for compliance with state regulations and ensuring that families receive the necessary child care assistance.

To get started on filling out the form, click the button below.

Create This Form Online

The Oregon Department of Human Services (ODHS) Child Care Provider Listing Form serves as a crucial document for both child care providers and parents seeking assistance with child care costs. This form is designed to help determine whether a provider needs to be licensed by the Office of Child Care (OCC) or if they qualify for license-exempt status. The form includes specific instructions tailored for different types of providers, including those who are licensed, non-relative caregivers, and relatives such as grandparents or siblings. For those providing care without a license, the form outlines necessary training requirements, such as courses on child care health and safety, recognizing child abuse, and CPR/First Aid. Additionally, providers must complete water testing for lead if they are not related to all children in their care. The form also emphasizes the importance of background checks for anyone involved in the care environment, ensuring the safety of the children. Once completed, the form must be submitted within a specified timeframe, and approval from OCC is required before any child care payments can be processed. Understanding these aspects is essential for anyone navigating the child care landscape in Oregon.

Instructions on Writing Oregon Dhs Child Care Provider

After you receive the Oregon DHS Child Care Provider form, follow these steps to complete it accurately. Ensure that all required information is filled out and that you meet the necessary training and testing requirements before submission.

  1. Obtain the Child Care Provider Listing Form from the parent.
  2. Determine if you need to be licensed with the Office of Child Care (OCC) based on your relationship to the children in care and the number of children you care for.
  3. If you are license-exempt non-relative care, complete the required trainings:
    • Introduction to Child Care Health & Safety training.
    • Recognizing and Reporting Child Abuse and Neglect training.
    • Infant/Toddler CPR/First Aid training.
  4. If you are license-exempt relative care, complete the Introduction to Child Care Health & Safety training.
  5. Test your water supply for lead if you are a non-relative care provider and submit the results with your form.
  6. Fill out the Child Care Provider Listing Form using black or blue ink.
  7. Sign the completed form.
  8. Mail the form within 30 days to the Direct Pay Unit at P.O. Box 14850, Salem, OR 97309-0850. You can also fax it to 503-378-5953 or email it as a PDF to DPU.childcarebilling@dhsoha.state.or.us.
  9. Contact the Direct Pay Unit at 1-800-699-9074 or 503-378-5500 if you have any questions.
  10. Prepare for a home/facility visit from OCC after your form is reviewed and trainings are verified.

Common Questions

What is the purpose of the Oregon DHS Child Care Provider form?

The Oregon DHS Child Care Provider form is used to collect information about child care providers in Oregon. It helps determine whether a provider needs to be licensed with the Office of Child Care (OCC) or if they qualify for license-exempt status. Completing this form is essential for providers who wish to receive payments for child care services through the Oregon Department of Human Services (ODHS).

Who should complete the Child Care Provider Listing Form?

The form must be completed by the child care provider. Parents should give the form to their chosen provider to fill out. It is important for the provider to understand their licensing status and to ensure they meet all necessary requirements before submitting the form.

What are the training requirements for license-exempt non-relative care providers?

License-exempt non-relative care providers must complete specific training before submitting the Child Care Provider Listing Form. This includes the Introduction to Child Care Health & Safety training, Recognizing and Reporting Child Abuse and Neglect training, and Infant/Toddler CPR/First Aid training. These trainings can be taken online or in-person, depending on the specific course.

What should a provider do if they need to test their water supply?

If a license-exempt child care provider is not related to all children in care, they must test their water supply for lead before submitting the form. A copy of the water sample results should be included with the listing form. If the provider offers care in the child's home and lives elsewhere, lead testing is not required.

How can a provider submit the completed Child Care Provider Listing Form?

The completed form can be submitted in several ways: by mail to the Direct Pay Unit at P.O. Box 14850, Salem, OR 97309-0850; by fax at 503-378-5953; or by email to DPU.childcarebilling@dhsoha.state.or.us in PDF format. It is crucial to submit the form within 30 days from the date issued in the "ODHS branch use only" section.

What happens after the form is submitted?

After the form is submitted, the OCC will conduct a home or facility visit to ensure it meets health and safety requirements. The OCC staff will contact the provider to schedule this visit. If the provider meets all requirements, they will be approved to receive child care payments from ODHS.

What are the consequences of failing to report changes as a child care provider?

Child care providers must report specific changes to the Direct Pay Unit within five days. These changes include arrests, changes in household members, or any new individuals with unsupervised access to children. Failure to report such changes may lead to a fail status or suspension as a child care provider, resulting in the inability to receive child care payments.

Misconceptions

  • Misconception 1: All child care providers must be licensed.
  • Not all child care providers need a license. If you are providing care for a small number of related children or meet specific criteria, you may be exempt from licensing.

  • Misconception 2: The form is only for licensed providers.
  • The Child Care Provider Listing Form is for both licensed and license-exempt providers. It helps determine eligibility for child care assistance.

  • Misconception 3: Training is optional for all providers.
  • Training is mandatory for certain providers, especially those who are license-exempt and not related to the children in care. Specific courses must be completed before submitting the form.

  • Misconception 4: Water testing is not necessary for all providers.
  • License-exempt providers who are not related to the children must test their water supply for lead. This requirement ensures the safety of the children in care.

  • Misconception 5: Background checks are not required for license-exempt providers.
  • Background checks are essential for all child care providers, including those who are license-exempt. This includes checks for everyone living in the home who is 16 years or older.

  • Misconception 6: The form can be submitted anytime after care begins.
  • The completed form must be submitted within 30 days from the date issued. Delays can affect payment eligibility for child care assistance.

  • Misconception 7: The form is a billing form.
  • This form is not for billing purposes. It is used to register as a provider and must be approved before any payment can be processed.

  • Misconception 8: Providers can ignore changes in their status.
  • Providers must report any changes, such as new arrests or changes in address, within five days. Failing to do so can result in suspension from receiving payments.

Similar forms

The Oregon Child Care Provider Listing Form shares similarities with the Child Care Provider Registration Form used in many states. Both documents require providers to disclose personal information, including their name, address, and the type of care they provide. Additionally, both forms often require providers to indicate their licensing status and any relevant training or certifications they have completed. This ensures that the child care provider meets the necessary standards for safety and care in their respective state.

Another comparable document is the Child Care Licensing Application, which is typically required for those seeking formal licensing. Like the Oregon form, this application collects detailed information about the provider's background, the facility's setup, and compliance with health and safety regulations. Both documents aim to ensure that child care providers are adequately vetted and qualified to care for children, fostering a safe environment for families.

When considering essential legal documents, it is important to examine various options available, including the All Georgia Forms, which provide specific templates for estate planning and ensure that one's personal and financial wishes are followed upon their passing. These forms help in maintaining clarity and organization in legal matters, thus alleviating potential conflicts among heirs and beneficiaries.

The Family Child Care Home Registration Form is another similar document. This form is used to register family child care homes with state agencies. It requires similar information about the provider, including their relationship to the children in care and their compliance with training requirements. Both forms serve to establish a record of child care providers and ensure they adhere to state regulations.

The Child Care Subsidy Application also resembles the Oregon DHS Child Care Provider form. While this application is primarily for families seeking financial assistance for child care services, it requires providers to submit their information as part of the approval process. This ensures that only approved providers are eligible for subsidies, maintaining accountability and quality in child care services.

The Health and Safety Checklist for Child Care Providers is another related document. This checklist is often used during inspections to assess compliance with safety regulations. Like the Oregon form, it emphasizes the importance of health and safety training and requires providers to demonstrate their readiness to care for children in a safe environment. Both documents aim to uphold high standards in child care settings.

Lastly, the Background Check Consent Form is crucial for child care providers. This document is required to conduct background checks on individuals who will have unsupervised access to children. Similar to the Oregon form, it emphasizes the importance of ensuring that all individuals involved in child care meet safety standards. Both documents aim to protect children by screening potential risks associated with caregivers.

Dos and Don'ts

When filling out the Oregon DHS Child Care Provider form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here’s a list of things to do and avoid:

  • Do read all instructions carefully before starting the form.
  • Do use black or blue ink when completing the form.
  • Do submit the form within 30 days from the date issued in the “ODHS branch use only” section.
  • Do attach any required documents, such as training certificates or water testing results.
  • Don't leave any sections blank; ensure all applicable fields are filled out.
  • Don't forget to contact the Direct Pay Unit if you have questions or need assistance.

Document Overview

Fact Name Description
Form Purpose The Oregon DHS Child Care Provider Listing Form is designed to collect necessary information from child care providers to determine their licensing status.
Licensing Requirement Child care providers in Oregon must be licensed with the Office of Child Care (OCC) unless they qualify for a license-exempt status.
Exemptions from Licensing Providers may be exempt if they care for three or fewer children, are related to the children in care, or provide care in the child’s home.
Training Requirements License-exempt non-relative providers must complete specific trainings, including Child Care Health & Safety and CPR/First Aid before submitting the form.
Water Testing Providers not related to all children in care must test their water supply for lead and submit results with the listing form.
Background Checks ODHS conducts FBI fingerprint background checks for all license-exempt child care providers and household members aged 16 and older.
Submission Guidelines The completed form must be mailed, faxed, or emailed within 30 days of the date issued to the Direct Pay Unit (DPU).
Child Care Payments Payments from ODHS for child care begin only after the listing form is approved and the family qualifies for child care benefits.
Reporting Changes Providers must report any significant changes, such as arrests or changes in household composition, to DPU within five days.