Fillable NJ CHILD CARE SUBSIDY PROGRAM (Department of Human Services Division of Family Development)

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NJ CHILD CARE SUBSIDY PROGRAM (Department of Human Services Division of Family Development)

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U.S.A. forms for Department of Human Services Division of Family Development

BROWSE DEPARTMENT OF HUMAN SERVICES DIVISION OF FAMILY DEVELOPMENT (NJ) FORMS

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1
NJ CHILD CARE SUBSIDY PROGRAM
Documentation Checklist
Below is a general list of required documents for each section of the Child Care Subsidy Program Application that must
be submitted for initial eligibility consideration. Additional documents may also be required based on program
requirements. Please contact and check with the Child Care Resource and Referral Agency (CCR&R) if you have
questions or need assistance. You can reach your local CCR&R at 1-800-332-9227 or by visiting www.ChildCareNJ.gov.
IDENTIFICATION
For each applicant/co-applicant, submit one of the documents from Column A. If you are unable to provide from
Column A, you may submit two documents from Column B:
COLUMN A (PRIMARY DOCUMENTATION)
Submit one:
OR
COLUMN B (SECONDARY DOCUMENTATION)
Submit two:
Driver’s License
Government Issued Photo ID Card
Military Photo ID Card
Employer Issued Photo ID
School Photo ID
Passport
Permanent Resident Card (Green Card)
High School Diploma, GED, or College Diploma
Health Insurance Card or Prescription Card
Printed Paystub
Birth Certificate (applicant/co-applicant or child’s)
Social Security Card
ADDRESS
For any applicant/co-applicant, submit one of the following to verify residence*:
Current Rental/Lease Agreement or Mortgage Bill
Court decree (if applicable)
School records showing residence
Custody Agreement or other court documents for
guardianship
Home utility bills
Medical documentation
Vehicle Registration or Title or NJ Driver’s License
Most recent filed tax forms showing dependency
(For dependents 18+, must provide filed IRS 1040 Form)
*If you or your child are homeless and do not have a fixed address, please contact your CCR&R for assistance.
RELATIONSHIP AND HOUSEHOLD SIZE
For any child in need of child care services, submit the following to prove relationship:
Child’s Birth Certificate
Court decree (if applicable)
Custody Agreement or other court documents for guardianship (if applicable)
For each dependent residing in the home and included in the family size, submit one of the following to verify family size:
Birth Certificate
Custody Agreement or other court documents for
guardianship (if applicable)
Court decree (if applicable)
Most recent filed tax forms showing dependency
(For dependents 18+, must provide filed IRS 1040 Form)
2
NJ CHILD CARE SUBSIDY PROGRAM
Documentation Checklist Continued
CHILD CITIZENSHIP STATUS

For any child in need of care, submit one of the following:
U.S. Birth Certificate
Certificate of Citizenship
U.S. Passport or Passport Card
Social Security Card
Permanent Resident Card (Green Card)
USCIS Form I-551 (Alien Registration Card)
Refugee Travel Document (Form I-571)
USCIS/INS Form I-94 stamped “Refugee”, “Parolee”,
“Asylee”, or “Notice of Action”
INCOME

INCOME FROM EMPLOYMENT:
OTHER INCOME OR BENEFITS TO FAMILY UNIT:
Must provide current one month’s worth of current pay
stubs (e.g. 4 weekly, 2 biweekly, etc.)
NEW EMPLOYMENT ONLY: If paystubs are not available
Employer letter on company letterhead (signed/dated)
Must include rate of pay, hours worked per week,
employer contact information, and first date of
employment; or
DFD “Verification of Employment” Form
If approved for subsidy, applicant/co-applicant will
be required to follow up with pay stubs.
SELF-EMPLOYED ONLY: Submit Current IRS Tax
Transcript of Form 1040 Schedule C, “Profit or Loss
from Business”
UNABLE TO WORK or INCAPACITATED: DFD
“Parent Incapacitation Verification” Form
Documentation must show the rate and frequency of the
income received from the sources below:
Unemployment documentation
Pension documentation
Worker’s Compensation
Social Security award letter
Retirement/Pension
Spousal Support/Alimony
Veterans/Military Benefits
Disability Benefits
Child Support – minimum of 6 months of
Payment/Disbursement History
(Note: If child support or alimony is not court ordered, write the
amount you receive monthly in Section C of the application)
Any other income required for federal/state tax
reporting purposes
SCHOOL/TRAINING
For each applicant/co-applicant, submit one of the following:
SCHOOL: Detailed school schedule naming the school and the student, including days and hours attending, credits,
start and end date
TRAINING PROGRAM:Letter on Program letterhead (signed/dated) indicating name of program, start and end
date and weekly schedule
DFD 10
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17
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NJ CHILD CARE SUBSIDY PROGRAM (Department of Human Services Division of Family Development)

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Completed 20 July 2020

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