PHL114/12.12.16 Page 1 of 1
VA LOAN CHILD CARE CERTIFICATION
This form is required on all standard VA loans (purchase and cash-out) and on credit qualifying IRRRLs if
dependents are disclosed or at underwriter discretion. This form is not required on non-credit qualifying IRRRLs.
Complete the following regarding child care expenses:
I/we have child care expenses in the amount of
$
per month.
I/we do not have child care expenses since our child/children are cared for at no cost by the
person identified below:
Name of child care provider:
Address:
City: State: Zip:
Phone Number:
Relationship (if any):
I/we do not have child care expenses as we have no dependent children or they no longer
require child care.
By signing below, I/we certify that the above information is true and correct.
Date
Date
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signature
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