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Eligibility Forms

Child Care Subsidy Forms for Parents

Note: All forms are in PDF format.

Form #

Form Name


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.


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.

012, 012A, 012B

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

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


Referral to Employer for Income Information

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


(Español) Remisión al Empleador para Información de Ingresos

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


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.


Housing Questionnaire

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


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


Income from Employment and Other Sources

Household income update for child care subsidy recertification


Household Information for Child Care Recertification

Verify household information for child care subsidy recertification


Documentation Required for Child Care Eligibility

List of documents needed for child care subsidy recertification


Recertfication Signature Page

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


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

Programs & Initiatives