Administration for Children's Services311Search all NYC.gov websites

Eligibility Forms

Child Care Subsidy Forms for Parents

Note: All forms are in PDF format.

Form #

Form Name

Purpose

CFWB 001 Special Needs Payment Rate Application Use this form if you are a Parent or Guardian who currently receives an ACS voucher and you are interested in requesting a Special Needs payment rate.

CFWB-005

Vocational, Education and Training Verification

Submit this form if your reason for care is school or vocational training attendance. This form documents your attendance at an approved education or training program at least 20 hours per week.

CFWB-005 Translations: العربية | বাংলা | Español | 繁體中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

CFWB-009

Referral of Suspected Childcare Subsidy Fraud

Use this form to report child care subsidy fraud in NYC.

CFWB-009 Translations: العربية | বাংলা | Español | 繁體中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

CFWB-010

Voucher Wait List Request Form

Form to be completed by families requesting to be added to the child care subsidy wait list.

CFWB-010 Translations: العربية | বাংলা | Español | 繁體中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

CFWB-012, 012A, 012B (Spanish)

Child Care Assistance Application Package

Apply for child care assistance. Package includes:

  • Cover page
  • Application (CFWB-012)
  • Instructions (CFWB-012A)
  • Submission Checklist (CFWB-012B)
  • Voter Registration Form

CFWB-012, 012A, 012B

Paquete de solicitud de asistencia para el cuidado infantil

Solicite ayuda para el cuidado de niños. El paquete incluye:

  • Página de portada
  • Aplicación (CFWB-012)
  • Instrucciones (CFWB-012A)
  • Lista de verificación de presentación (CFWB-012B)
  • Formulario de registro de votantes

CFWB-015

Referral to Employer for Income Information

Use this form to verify your income if pay stubs are not available.

CFWB-015Sp

(Español) Remisión al Empleador para Información de Ingresos

Use este formulario para verificar sus ingresos si los recibos de sueldo no están disponibles.

CFWB-026

Work Search Record

Use this form if your reason for care is looking for work if you do not have a current benefits rate letter from New York State Unemployment Benefits.

CFWB-026 Translations: العربية | বাংলা | Español | 繁體中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

CFWB-027

Housing Questionnaire

Use this form if your reason for care is temporary housing.

CFWB-027 Translations: العربية | বাংলা | Español | 繁體中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

Forms for Child Care Subsidy Recertification (Mail completed forms to your Resource Area. These were mailed to you prior to your recertification date):

CFWB-020

Income from Employment and Other Sources

Household income update for child care subsidy recertification

CFWB-020 Translations: العربية | বাংলা | Español | 繁體中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

ECE-021

Household Information for Child Care Recertification

Verify household information for child care subsidy recertification

CFWB-022

Documentation Required for Child Care Eligibility

List of documents needed for child care subsidy recertification

CFWB-022 Translations: العربية | বাংলা | Español | 繁體中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

CFWB-024

Recertfication Signature Page

Sign and submit this form to certify family's eligibility for continued receipt of child care subsidy

CFWB-024 Translations: العربية | বাংলা | Español | 繁體中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

ECE-025

Child Care Services for Eligible Families

Child Care options for families determined eligible for subsidized child care, including families whose Transitional Child Care (TCC) benefit is ending

CFWB-045A

Attestation during COVID-19 Public Health for Application

(Please complete this form if your documentation required for application cannot be completed due to the COVID-19 public health emergency.)

CFWB-045 Translations: العربية | বাংলা | 繁體中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

CFWB-045A-Spanish

Declaraciones juradas durante la Emergencia de Salud Pública de COVID-19

(Por favor, complete este formulario si la documentación que requiere para la solicitud no se puede completar debido a la emergencia de salud pública de COVID-19).

CFWB-045B

Attestation during COVID-19 Public Health for Recertification

(Please complete this form if your documentation required for recertification cannot be completed due to the COVID-19 public health emergency.)

CFWB-045B-Spanish

Declaraciones juradas durante la Emergencia de Salud Pública de COVID-19

(Por favor, complete este formulario si la documentación que requiere para la recertificación no se puede completar debido a la emergencia de salud pública de COVID-19).

CFWB-046

Request for School-Age Care During the School Day

For a parent to request child care assistance if their child attends a child care program when not required to be physically present in school as part of the regular school day due to COVID-19.


Programs & Initiatives