Provider Cost Verification Form Introduction & Instruction
The Provider Cost Verification Form collects all required information about the child care rates your
family will be charged by the child care provider. This includes discounts, registration fees, effective
dates, rate changes, rate frequency, and the schedule of care. This form will be used to process your fee
assistance application and ensure that no overpayments occur.
You will be required to submit this form with your family application after it has been confirmed that
your child care provider is eligible to participate in the fee assistance programs. To review the provider
eligibility requirements, visit
https://usa.childcareaware.org/feeassistancerespiteproviders/feeassistance/. You may also call and
speak with a specialist at 1-800-424-2246. Please see the guidelines below for completing the form.
Instructions:
1. You should VERIFY that the provider is eligible to participate in the fee assistance programs
before completing the form.
2. Your Child Care Provider should COMPLETE the form.
a. Rates listed on the form should be the rates before and after discounts are applied. For
example, a rate that is $300 per week rate with a 10% sibling discount should be listed
on the form as $270 per week.
b. All rate changes should be included on the form, including new rates for classroom
changes and age changes.
c. If your provider does not know the exact date of a rate change, please have them
provide their best estimate as to when the rate change will occur. If it is an estimate,
they should indicate that on the form. Annual facility rate increases cannot be processed
unless it is provided in this form or on the provider’s rate sheet prior to the family’s
approval.
d. Registration Fee*: Fees that are inclusive of purchases for diapers, supplies and
materials, or any additional items/services will not be covered and should not be
included in the registration fee.
3. The form needs to be SIGNED by both the provider and the guardian.
4. The form is then SUBMITTED by the family with the family application.
5. The information provided on this form should be consistent with the information provided on
the Rate Verification Form.
6. Fee assistance is determined by calculating the difference between your child care facility’s
monthly fee and the DoD parent fee for similar child care services at the closest military
installation. If your facility charges weekly, CCAoA will convert your weekly fee into a monthly
fee by multiplying it by 4.33. (This calculation takes into account all months within the year
whether they have 4 or 5 weeks.) Please note that the rate conversion (if required) will be
performed by CCAoA at the time a fee assistance approval is granted and does not need to be
calculated beforehand. The branch Sponsor is responsible for the DoD-established parent fees
that sponsors pay on post, and any amount over the provider rate cap of $1500.
*Disclaimer: The registration fee may not be covered if a family’s previous provider received coverage or if the Fee
Assistance Program’s branch does not cover the fee. Please note that failure to correctly report information will
result in removal from the fee assistance program. In the event of overpayment Child Care Aware® of America will
notify the Army. All monies must be paid back to Child Care Aware® of America Fee Assistance Programs.
Completing this form does not certify that the provider will qualify for the fee assistance program. In the event of
overpayment, Child Care Aware® of America will notify the branch of service.
