Oregon Dhs Child Care Provider Template

Oregon Dhs Child Care Provider Template

The Oregon DHS Child Care Provider form is a crucial document designed to streamline the process for child care providers in determining their licensing requirements with the Office of Child Care (OCC). It serves as a comprehensive guide for providers to assess whether they need to be licensed based on their specific care circumstances and outlines the steps required for license-exempt providers to comply with necessary trainings and safety regulations. By facilitating this process, the form plays an integral role in ensuring the well-being and safety of children in Oregon's diverse child care settings.

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In Oregon, the journey of becoming a child care provider involves navigating through various processes as mandated by the Department of Human Services (DHS), whether you are a new entrant into the field or an existing provider. The Oregon DHS Child Care Provider form serves as a critical juncture for providers entering or operating within the childcare landscape, addressing the need to meet certain standards and requirements. This exhaustive document offers step-by-step guidance for both license-exempt and licensed providers, covering aspects from licensing exemptions to mandatory training and background checks. Importantly, it outlines the necessity for certain providers to undergo health and safety training, CPR/First Aid certification, and even water testing for lead, underlining the commitment of the state to safeguard the health and welfare of children in care. Additionally, the form details the procedural steps for submission and the subsequent processes, including a home or facility visit by the Office of Child Care (OCC). Moreover, it highlights the requirement for continuous communication with DHS, especially in reporting any significant changes that may affect the provider's status. The importance of this form is further underscored by its role in facilitating child care payments from ODHS to eligible families, streamlining the bureaucratic intricacies into a navigable pathway for aspiring and current child care providers in Oregon.

Preview - Oregon Dhs Child Care Provider Form

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Child Care Provider Listing
Form Instructions
Parent: Please immediately give this form to your
child care provider to complete.
Provider: For help completing this form contact your local Child Care Resource and Referral
(CCR&R) office. To find an office near you call: CCR&R Centralized Coordination at 1-800-342-6712
(toll-free)
Licensing and license-exempt status
» If you are currently licensed with the Child Care Licensing Division (CCLD), go to page 4 for instructions.
» If you are not licensed with CCLD and:
• You are not related to all children in care.
» You are likely providing license-exempt non-relative care. Go to page 2 of the instructions.
• You are a grandparent, great-grandparent, aunt, uncle (does not include great-aunt and great-
uncle) or a sibling (siblings must not live in the same home as the child needing care). Relationships
must be by blood, adoption or marriage. This includes blood relationships established before the
child was adopted. Relationships by marriage continue even if a spouse dies.
» You are likely providing license-exempt relative care. Go to page 3 of the instructions.
Are you required to be licensed with the Child Care Licensing Division?
Child care providers are legally required to be licensed with CCLD unless they are exempt
from licensing (license-exempt).
How to determine your license or license-exempt status
Please select all the statements below that apply to you.
If you provide care in a home, you are exempt from licensing if:
You are providing c
are in the home of the child but do not live with the child.
All the children you care for, not including your own children, are from the same family.
You are caring for three or fewer children, not including your own children, at any one time.
You are related to the children in care by blood, marriage or adoption.
If you provide care in a facility, you are exempt from licensing if:
You do not care for children more than 70 days in a year.
A school district, political subdivision of the state or a governmental agency operates the program.
You are operating a pre-school recorded program.
If you meet one of the above exemptions, CCLD may not require licensing of your home or facility.
To see if you need to be licensed, call CCLD at 503-947-1400 or 1-800-556-6616.
The Department of Early Learning and Care (DELC) uses this information to help determine if you
need to be licensed with CCLD. This is an informational tool only.
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Instructions for license-exempt non-relative care
Training
If CCLD does not require you to have a license and you are not related to all children in care, you will
need to complete the following before submitting a completed Child Care Provider Listing Form:
• Introduction to Child Care Health & Safety training (take online)
» Online training: www.oregon.gov/delc/programs/pages/erdc-training.aspx
• Recognizing and Reporting Child Abuse and Neglect training
» In-person training: Contact your local CCR&R at 1-800-342-6712 or
» Online training: www.oregon.gov/delc/programs/pages/erdc-training.aspx
• Infant/Toddler CPR/First Aid training
For training locations, contact your local CCR&R at 1-800-342-6712. If you are unable to take the
Infant/Toddler CPR/First Aid class before turning in this form, you may be eligible for a short-term
waiver. Contact your local CCR&R for more information about the waiver process. For a list of
CCR&R offices, go to www.oregonccrr.org, call 1-800-342-6712 or call 211 Info. Strictly online CPR
training is not acceptable.
Attach a copy of your “Infant/Toddler CPR/First Aid Card” to this form if you took this training from
another agency besides the local CCR&R.
Note: The director and staff members who work with children in care and volunteers who may have
unsupervised access to children are also required to take the above trainings.
Water testing requirements
License-exempt child care providers who are not related to all children in care must test their water
supply for lead in any plumbing fixture used for drinking, preparing food or formula before submitting
their Child Care Provider Listing Form. Submit a copy of the water sample results with your listing form.
Please note: Lead testing is not needed if you provide care in the child’s home and you live somewhere
else.
CCLD can reimburse you for the cost of lead testing. For a reimbursement form and information on
how to test your water, visit www.oregon.gov/delc/providers/pages/lead-testing.aspx.
For information on preventing exposure to lead, contact CCLD at 503-947-5908 or visit their website at
www.oregon.gov/delc/providers/pages/lead-testing.aspx.
After completing the above trainings and water testing:
• Complete and sign the attached Child Care Provider Listing Form using black or blue ink.
• Mail the form within 30 days from the date issued in the “ODHS branch use only” section. Mail to
the Direct Pay Unit (DPU) at P.O. Box 14850, Salem, OR 97309-0850, fax to 503-378-5953 or email
• Contact DPU for questions at: 1-800-699-9074 (toll-free) or 503-378-5500 (Salem area).
• Complete the Central Background Registry (CBR) application to start the process for background
checks. To get the CBR application go to: www.oregon.gov/DELC or call CCLD at 1-800-556-6616.
For more information see page 9. You can either download, print, and mail the application or fill
out the online application and submit it electronically to CCLD.
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• CCLD must conduct a home/facility visit before approving you as a child care provider. This also
includes care provided in the child’s home. After DELC reviews your provider listing form and verifies
you have completed trainings, an CCLD staff person will contact you to schedule a visit where child
care will be provided. The CCLD staff person will check to make sure the home/facility meets all
health and safety requirements as required by DELC. The staff person can talk with you about
concerns or questions you have and share resources or training material.
» Before this visit, you may review the CCLD's Health and Safety Checklist. Find the checklist at
www.oregon.gov/DHS/ASSISTANCE/CHILD-CARE/Documents/Regulated-Subsidy-Checklist-
RS-404.pdf.
Please also see section “Additional information for both relative and non-relative license-exempt
providers” below.
Instructions for license-exempt relative care
Note: A relative is a grandparent, great-grandparent, aunt, uncle (does not include great-aunt and
great-uncle) or a sibling (not living in the home of the child).
Training
If you are not required to be licensed with CCLD and you are related to the child or children in care, you
will need to complete the following before submitting a completed Child Care Provider Listing Form:
• Introduction to Child Care Health & Safety training (take online)
For more information, go to www.oregon.gov/delc/programs/pages/erdc-training.aspx.
After completing the above training:
• Complete and sign the attached Child Care Provider Listing Form using black or blue ink.
• Mail the form within 30 days from the date issued in the “ODHS branch use only” section. Mail
to the Direct Pay Unit at P.O. Box 14850, Salem, OR 97309-0850, fax to 503-378-5953 or email
DPU.childcarebilling@delc.oregon.gov (PDF only).
• Contact DPU for questions at 1-800-699-9074 (toll-free) or 503-378-5500 (Salem area).
• Complete the Central Background Registry (CBR) application to start the process for background
checks. To get the CBR application go to: www.oregon.gov/DELC or call CCLD at
1-800-556-6616 to get an application. For more information see page 9. You can either download,
print, and mail the application or fill out the online application and submit it electronically to CCLD.
Additional information for both relative and non-relative
license-exempt providers
Background checks
The Child Care Licensing Division (CCLD runs background checks through the Central
Background Registry (CBR).
Providers and household members will need to fill out the Central Background Registry (CBR)
application. CCLD will then conduct the background checks. To get the CBR application go
to: www.oregon.gov/DELC or call CCLD at
1-800-556-6616 to get an application.
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DELC 7494d (07/2023) recycle prior versions
Background checks include fingerprints through both the Oregon State Police and the Federal Bureau
of Investigation (FBI). Checks also includes: criminal history check and sex offender check through the
Law Enforcement Database System (LEDS), Child Protective Services (CPS) and Adult Protective
Services (APS) history check through Oregon Department of Human Services, Oregon court records
check, and a check of the National Sex Offender Registry.
Individuals who have lived outside of Oregon within the last five (5) years of their CBR application
submission may receive state specific instruction for additional out of state checks. Background checks
are required for the provider, any member of the household who is age 18 or older, volunteers, and any
visitors to the home who may have unsupervised access to a child in care. A visitor is someone who
may spend time at the provider’s home during the time child care is provided but does not live in the
home. This is likely when the provider needs to visit another area of the home (bathroom, bedrooms,
kitchen), leaving the visitor an opportunity for unsupervised access to children.
» In facilities exempt from licensing, the site director and everyone who works in the facility who
will have access to the children in care need criminal and child protective service records
checks. This includes employees, substitute caregivers, staff and volunteers who may have an
opportunity for unsupervised access to children.
Important:
Providers and individuals will need to be enrolled in the CBR prior to being approved to receive child
care subsidy payments
Submit the CBR application to CCLD when submitting the Child Care Provider Listing form to DPU in
order for the background checks to be completed timely.
Instructions for CCLD licensed child care providers (registered
family, certified family, certified center)
Licensed providers with CCLD are required to:
• Meet ERDC provider requirements and health and safety standards.
• Complete and sign the attached Child Care Provider Listing Form using black or blue ink.
• Mail the form within 30 days from the date issued in the “ODHS branch use only” section.
Mail to the Direct Pay Unit at P.O. Box 14850, Salem, OR 97309-0850, fax to
503-378-5953 or email DPU.childcarebilling@delc.oregon.gov (PDF only).
A Child Care Provider Listing Form is required for each site where care is provided. DPU will need to
list and approve each site to receive subsidy child care payments.
Contact DPU for questions at 1-800-699-9074 (toll-free) or 503-378-5500 (Salem area). Child care
payments from DELC begin once the listing form has been approved and the family is eligible for child
care benefits.
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Important information for all
child care providers
Notice
The Oregon Department of Early Learning and Care (DELC) helps pay child care costs for families
receiving child care assistance. The family may have to pay for some of the care, including the first
month of service, if DELC does not approve their provider’s listing before their child starts care.
Providers are required to meet all DELC standards and provider requirements to be eligible for
payment from DELC. For full standards and requirements, see the ERDC Child Care Provider Guide
(DELC 7492) or visit www.oregon.gov/delc/providers.
• This is not a billing form. You will receive a billing form in the mail if DELC approves you to receive
payment as a child care provider and the parent is eligible for child care assistance.
• The family may also be responsible to pay for some of the care, including the first month of care.
• If there is more than one provider for a child, each provider will receive a percentage of the hours for
each month.
• For more information regarding child care, go to the DELC child care information website:
www.oregon.gov/DELC.
• By supplying your email address in #3 of the listing form, DELC will email you important information
on the child care program.
Important contacts
• Direct Pay Unit (DPU): P.O. Box 14850,
Salem, OR 97309-0850, 1-800-699-9074 (toll-free) or
503-378-5500 (Salem area) or email customerservice.dpu@delc.oregon.gov
• Child Care Licensing Division: 1-800-556-6616 or email CC[email protected]
» To get the CBR application go to: www.oregon.gov/DELC or call CCLD to get an application. For
more information see page 9. You can either download, print, and mail the application or fill out
the online application and submit it electronically to CCLD
• Child Care Resource and Referral Centralized Coordination: 1-800-342-6712 (toll-free).
They can help you fill out this form.
• 211 info: Dial 211 or
text the keyword “children” to 898211 or email [email protected]
• SEIU — Union for l icense
-exempt providers: 1-844-503-SEIU (7348)
• AFSCME — Union for CCLD l icensed providers: 1-800-521-5954
Reporting changes
All child care providers are required to report the following changes to DPU within five days by
calling 1-800-699-9074 or 503-378-5500 or by emailing DPU.ProviderReporting@delc.oregon.gov:
• Any new arrests, indictments, convictions or involvement with Child Protective Services (Child
Welfare) or any other agencies providing child or adult protective services by any of the following:
» You
» Any person living with you age 18 and older
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» Visitors
» Each person supervising a child in the provider’s absence
» The site director of an exempt child care facility and anyone who works in the facility who has
access to the children in care, including employees, substitute caregivers, staff and volunteers
and
» Any other person required to be on the listing form.
• Any change to the provider’s name, phone number or address including any location where care
is provided
• Any new person (age 18 and older) in the home or facility, including visitors to the home or facility
during the hours care is provided who may have unsupervised access to the children in care
• If I am now licensed with CCLD or have changed my license type with CCLD
• If I am no longer licensed with CCLD
• If I no longer meet ERDC provider requirements including health and safety requirements
• If I am now a home care worker for any ODHS Aging and People with Disabilities programs or
personal support worker through any Intellectual and Developmental Disability (IDD) or Oregon
Health Authority (OHA) Behavioral Health Services program
• If I am a home care worker or personal support worker, I will notify DPU if any changes occur with
the type of care I provide or if clients have been added to my care
Failure to report changes may result in a fail status or suspension as a child care provider and you will
not be able to receive child care payments.
Frequ
ently asked questions and full standards and requirements
See the ERDC Child Care Provider Guide (DELC 7492) or visit: www.oregon.gov/DELC.
Where to submit the completed form
By mail: Direct Pay Unit, P.O. Box 14850, Salem, OR 97309-0850
By fax: 503-378-5953
By email: DPU.childcarebilling@delc.oregon.gov (PDF only)
Questions? Call 1-800-699-9074 (toll-free) or 503-378-5500 (Salem area)
Where to submit a completed Central Background Check
Registry application
Online Application: www.oregon.gov/DELC You can either download, print, and mail the application
or fill out the online application and submit it electronically to CCLD
By mail: Child Care Licensing Division, 700 Summer St. NE, Salem, OR 97301
Questions call CCLD at: 1-800-556-6616 or email CCLD.customerservice@delc.oregon.gov
you
r o
wn
home
.
)
Yes No
If yes, attach a letter from the ODHS foster care certifier approving you to do child care in that home or your
listing will be failed.
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Child Care Provider Listing Form
All child care providers are
required to complete this form.
ODHS branch use only
DPU
DPU worker: Provider number: Notes:
Child care provider section — use blue or black ink
1. Name as it appears on IRS records: 2. SSN or IRS number: 3. Email:
4. Name to be printed on the check: 5. Address where you provide child care*: City: State: ZIP:
6. Phone number:
( )
-
7. Address where you live: City: State: ZIP:
8. What language do you prefer? 9. Mailing address (if different): City: State: ZIP:
* Note: If you provide child care at more than one address, attach a separate sheet of paper with the
additional addresses. License exempt facilities needs to submit a 7494 for each location where
care will be provided.
10.
Check this box if you are currently lic
ensed with the Child Care Licensing Division (CCLD).
Write your CCLD license number here: ________________________
11.
Check this box if you are a child care facility that is exempt from l
icensing with CCLD
12. Ethnicity:
Racial heritage:
Hispanic/Latino
Asian
Not Hispanic/Latino
White
American Indian/Alaska Native
Black or African American Native
Hawaiian/Pacific Islander
You can choose not to give the above ethnicity and racial heritage information. Your provider status will not
be affected.
13. Is the home where care is being provided foster care certified? (This applies if you provide care in
14. Do you provide (or will you provide) child care in the home where the child lives?
Yes No
PRE
-LIST
d) Are you working o
r a
pproved to be a personal support worker (PSW) through any ODHS
Intellectual and Development Disability (I/DD)? Yes No
e) If yes, write your provider number here even if you do not currently have clients:
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15. a) Are you working or approved to be a homecare worker (HCW) through any Aging and People with
Disabilities (APD) programs? Yes No
b) If yes, write your provider number here even if you do not currently have clients:
c) Are you currently providing service for client(s) in APD programs?
Yes No
f) Are you currently providing service for client(s) in I/DD programs? Yes No
If you are a homecare
or personal support worker and you are currently servicing clients, please attach
a separate paper with your work schedules (days/times) for each type of care you provide (or will
provide), as well as the child care schedule. The listing form is incomplete and will be returned if
schedules are not attached. Additional information may be requested to determine child care
provider eligibility.
Notify DPU if changes occur with the type of care you provide or if you have added clients to your
care.
16. List the children of the ERDC families who will be in your care. (Attach a separate paper if necessary.)
Child’s name (first and last)
child in care:
Grandparent Great grandparent Sibling
Aunt or uncle (do not include great) Not related
Grandparent Great grandparent Sibling
Aunt or uncle (do not include great) Not related
Grandparent Great grandparent Sibling
Aunt or uncle (do not include great) Not related
*Relationships must be by blood, adoption or marriage. This includes biological relatives. Relationships
by marriage continue even if a spouse dies.
Please answer the following questions:
Yes No
Yes No
Yes No
17. I am the parent, stepparent or legal guardian of the child in care.
18. I am on the same Temporary Assistance to Needy Families (TANF)
case or
Employment Related Day Care (ERDC) case as the child.
19. I am a sibling and live in the same household of the child who will be in care.
20. I hold a medical marijuana card or distribute, grow or use marijuana (including
medical marijuana) or any controlled substance (except lawfully prescribed and
over-the-counter medications).
Yes No
If you answered “Yes” to any of the above questions, you are not eligible to be listed as an ERDC
child care provider. Do not proceed.
Birth date Check the correct box if you are a relative* of the
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21. Basic provider requirements
All child care providers, including those licensed with CCLD are
Do you meet the
requirements?
A. If required by law, I will be licensed with the Child Care Licensing Division (CCLD).
See the page 1 of instructions section for more information.
Yes No
B. I am age 18 years of age or older and I understand that I am legally responsible
for the accuracy of this form and to repay any payment made in error.
Yes No
C. I am the actual person or facility providing care for the children. Yes No
D. I am competent and have sound judgement and self-control when working
with children.
Yes No
E. I am mentally, physically and emotionally capable of performing duties related
to child care.
Yes No
F. I will keep billing records and daily attendance records that show the check-in and
check-out times each day for each child in care (for no less than 12 months).
Yes No
G. If requested, I will allow DELC and ODHS to review billing records and attendance
records. I understand that I will incur an overpayment when attendance
records are not submitted for verification.
Yes No
H. I will treat ERDC families the same as other families receiving care
including charging ERDC families the same rate (or less) than I normally
charge non-ERDC families.
Yes No
I. I agree to have or develop a policy for removal and suspension of a child from
the child care setting and communicate this policy to parents/caregivers.
Yes No
J. I agree to complete the Foundation for Learning training within 90 days of
being approved if I am not required to be licensed with CCLD and am
not related to all children in care.
Yes No
N/A
K. I agree to complete the DELC Child Care Orientation Part 1 and Part 2
trainings within 90 days of being approved with DELC if I am not required
to be licensed with CCLD am a new provider or am relisting after a break
of one year or more.
Yes
No
N/A
L. I agree to complete an additional 6 hours of training each 2 years. Trainings
include 2 hours in Human Growth and Development & 2 hours in a core
knowledge category of my choice. I also agree to take an annual health &
Safety Training. These trainings are for providers not required to be licensed
with CCLD and not related to all children in care. See the Child Care Provider
Guide for more information.
Yes No
N/A
M. I will allow DELC and ODHS to inspect or visit the site of care during the hours
child care is provided.
Yes No
N. I will provide proof that I meet the DELC requirements when requested. Yes No
If you answered “No” to any of the above questions, you are not eligible to be listed as an ERDC
child care provider. Do not proceed.
required to answer this section.
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22. Home/facility requirements
Does your
home/facility
meet the
requirements?
Yes No
A. Does each floor used by children have two u
sable outdoor exits? (This can
include a sliding door or window that can be used to evacuate children.)
1. If there is a second floor used for child care, I have or will have a written plan
for evacuating children.
Yes No
N/A
Yes No
B. Does the home/facility have safe water for drinking or preparing food?
1. If you are a license-exempt provider not related to all children in care, have
you attached the lead test results to this form? See the information page 2
for more information.
Yes No
N/A
C. Does the home/facility have a working smoke detector on each floor and in each
area where children nap?
Yes No
D. Will you ensure that the building, grounds, toys, equipment and furniture are
clean, sanitary and hazard-free?
Yes No
E. Does the home/facility have a working telephone? (You must note phone number
in question 6.)
Yes No
F. Are there barriers to protect children from fireplaces, space heaters, electric
outlets, wood stoves, stairways, pools, ponds and other hazards. All gates and
enclosures must not pose a risk or hazard to any child in care.
Yes No
G. Will you ensure that items dangerous to children are kept in a secure place out of
a child’s reach? These items include firearms, ammunition, alcohol, inhalants,
tobacco and e-cigarette products, matches and lighters, any legally prescribed
or over-the-counter medicine, cleaning supplies, paint, plastic bags, and
poisonous and toxic materials.
Yes No
If you answered “No” to any of the above questions, you are not eligible to be listed as an ERDC
child care provider. Do not proceed.
23. Promoting safety
All child care providers, including those licensed with CCLD are
required to answer this section.
Do you meet the
requirements?
A. I will make sure that no one smokes or carries any lighted smoking instrument,
including e-cigarettes and vaporizers:
• In the home or facility or within 10 feet of any entrance, exit, window that opens,
or any ventilation intake that serves an enclosed area, during child care
operational hours or anytime child care children are present and
• In motor vehicles when child care children are passengers.
Yes No
All child care providers, including those licensed with CCLD are
required to answer this section.
If CCLD does not require you to be licensed (exempt from licensing), there may
be help in meeting the following requirements. Please contact DPU for more
information. You may print a safety and quality reimbursement form at:
https://wou.edu/tri/forms/.

File Features

Fact Detail
Purpose The Oregon DHS Child Care Provider form is used to determine if a child care provider needs to be licensed by the Office of Child Care (OCC) and to facilitate payment from ODHS for child care services.
Licensing Requirement Child care providers in Oregon are required to be licensed unless they meet specific exemption criteria outlined by the OCC.
Exemptions from Licensing Providers are exempt from licensing if they only provide care in the child's home, care for children from one family, or care for three or fewer children at any one time, among other specific conditions.
Training Requirements for License-exempt Providers License-exempt providers must complete training in child care health and safety, recognizing and reporting child abuse and neglect, and infant/toddler CPR/First Aid.
Water Testing Requirement License-exempt non-relative providers must test their water for lead and submit the results unless care is provided in the child’s home and they live elsewhere.
Governing Law The form and its requirements are governed by Oregon state law, specifically regulations set by the Office of Child Care and the Oregon Department of Human Services (ODHS).
Background Checks ODHS conducts FBI fingerprint background checks for license-exempt child care providers, including checks for any household members over the age of 16 and visitors with unsupervised access to children.
Reporting Changes Providers must report any changes such as new arrests, address changes, or a change in license status to the Direct Pay Unit within five days.
Submission Information The completed form must be mailed, faxed, or emailed (PDF only) to the Direct Pay Unit within 30 days from the issue date, along with any required training certificates or water test results.

Detailed Steps for Using Oregon Dhs Child Care Provider

Filling out the Oregon DHS Child Care Provider form is a crucial step for child care providers to be officially recognized and possibly reimbursed for their services. This process involves determining your license or license-exempt status, completing necessary trainings, conducting water lead testing (if applicable), and submitting the form correctly. Follow these steps carefully to ensure your application is submitted properly.

  1. Verify your license or license-exempt status based on the care you provide. Review the list on page 1 of the instructions to understand your category.
  2. If you are providing license-exempt non-relative care, complete the required trainings:
    • Introduction to Child Care Health & Safety (online)
    • Recognizing and Reporting Child Abuse and Neglect (online or in-person)
    • Infant/Toddler CPR/First Aid (contact your local CCR&R for training locations, not strictly online)
  3. If providing license-exempt relative care, complete the Introduction to Child Care Health & Safety online training.
  4. If water testing is applicable (not providing care in the child's own home), test your water for lead and attach the results to the form. Visit https://www.oregon.gov/DHS/ASSISTANCE/CHILD-CARE/Pages/Providers.aspx for reimbursement information and testing procedures.
  5. Fill out the Child Care Provider Listing Form in black or blue ink. Be thorough and accurate in your responses.
  6. Sign the completed form to verify the accuracy and completeness of the information provided.
  7. Mail the form within 30 days from the date issued in the "ODHS branch use only" section to:
    Direct Pay Unit (DPU),
    P.O. Box 14850,
    Salem, OR 97309-0850.
    Alternatively, you can fax it to 503-378-5953 or email to [email protected] (PDF only).
  8. Contact the Direct Pay Unit (DPU) at 1-800-699-9074 (toll-free) or 503-378-5500 (Salem area) if you have any questions.
  9. Prepare for OCC's visit to inspect your home/facility for health and safety requirements. Review the Health and Safety Checklist available at https://www.oregon.gov/DHS/ASSISTANCE/CHILD-CARE/Documents/Regulated-Subsidy-Checklist-RS-404.pdf.
  10. Report any changes to your situation as outlined on page 3 of the instructions to ensure compliance and maintain eligibility for child care payments.

Following these steps diligently is essential for ensuring your listing form is accepted and that you're in compliance with the requirements. This will not only formalize your role as a child care provider but also ensure you're eligible for any applicable reimbursements from the Oregon Department of Human Services.

Important Points on This Form

To comply with the requirements, you'll need to complete specific trainings before submitting the Child Care Provider Listing Form. These include an Introduction to Child Care Health & Safety training, available online, a course on Recognizing and Reporting Child Abuse and Neglect, and an Infant/Toddler CPR/First Aid training. For the CPR/First Aid training, remember that strictly online versions aren't accepted. Also, it's essential to conduct a lead test in your water supply and attach the results to your form unless you're providing care in the child's home and live elsewhere. For further assistance, contacting your local Child Care Resource and Referral (CCR&R) office is a good step.

What are the requirements for license-exempt relative child care providers?

If you're a relative providing care and exempt from licensing, you are required to complete the Introduction to Child Care Health & Safety training available online. After completing this training, remember to fill out the Child Care Provider Listing Form with black or blue ink and send it to the Direct Pay Unit. It's crucial to submit this form within 30 days from the date mentioned in the "ODHS branch use only" section of the form.

How do I know if I need to be licensed with the Office of Child Care (OCC)?

Child care providers in Oregon are generally required to be licensed unless they meet specific exemptions. Exemptions include caring for children in their home if not living with them, caring for children from one family, taking care of three or fewer children (excluding your own), or operating under limited days and specific organizational exemptions for facilities. If you're unsure whether you meet these exemptions or need further clarification, contacting OCC directly is advisable.

What are the water testing requirements for license-exempt providers?

If you're not related to all children in your care, you'll need to test your water supply for lead at any plumbing fixture used for drinking, preparing food, or formula. This test should be done before submitting your Provider Listing Form. However, this requirement doesn't apply if you're providing care in the child's home and live elsewhere. The Office of Child Care offers reimbursements for the cost of lead testing, and you should attach your water sample results to your listing form.

What is the process after submitting the Child Care Provider Listing Form?

After you have completed all required trainings, done the necessary testing, and submitted your Child Care Provider Listing Form, the Oregon Department of Human Services (ODHS) will review your submission. An OCC staff person will then contact you to schedule a visit to the location where child care will be provided. This visit is to ensure that your home or facility meets all health and safety requirements. It's also an opportunity for you to discuss any concerns and receive additional information or training materials.

What information is required for the background checks?

ODHS conducts FBI fingerprint background checks for all license-exempt child care providers. This includes checks for the provider, household members aged 16 or older, and any visitors who might have unsupervised access to children in care. If you or others have lived in the state for less than five years, additional checks for child welfare, sex offender, and criminal interstate records will be required. Details on how to submit fingerprints will be provided in a letter after submitting your Provider Listing Form.

How can I report changes to my child care environment or status?

If there are any changes to your situation, including new arrests, changes in household members, or changes in your licensing status, you must report these to the DPU within five days. You can report changes by calling the DPU directly, emailing, or in some cases, updates may be necessary by mail. Failure to report changes can affect your status as a child care provider and your ability to receive child care payments.

Common mistakes

  1. Not contacting the local Child Care Resource and Referral (CCR&R) office for assistance in filling out the form, which can lead to misunderstandings of the requirements and errors in completion.

  2. Failing to correctly determine their license or license-exempt status, which is essential for understanding what sections of the form apply to them and which trainings are required.

  3. Using ink colors other than black or blue to complete the form, which can result in the form not being processed correctly.

  4. Not completing mandatory training before submitting the form, such as the Introduction to Child Care Health & Safety training, Recognizing and Reporting Child Abuse and Neglect training, and Infant/Toddler CPR/First Aid training.

  5. Omitting the water sample results for lead testing from the submission, which is a requirement for license-exempt non-relative care providers.

  6. Overlooking to attach a copy of the “Infant/Toddler CPR/First Aid Card” if the training was taken from another agency besides the local CCR&R.

  7. Missing the deadline to mail the form within 30 days from the date issued in the “ODHS branch use only” section, which can delay the approval process.

  8. Not including an email address or providing an incorrect email address, which means they miss important updates or information about the child care program.

  9. Forgetting to report changes to DPU (Direct Pay Unit) within five days, such as new arrests or changes in location where care is provided, which can affect their status as a qualified provider.

  10. Neglecting to review the OCC’s Health and Safety Checklist before the visit by OCC staff to ensure the home/facility meets all health and safety requirements.

These mistakes impact the accuracy of the application and can delay or prohibit the provider from receiving approval and subsidy child care payments from the Oregon Department of Human Services (ODHS).

Documents used along the form

When completing the Oregon DHS Child Care Provider Listing Form, it's essential to be aware of the additional documentation that may be required or beneficial to streamline the process and ensure compliance with all regulations. Here's a brief overview of other forms and documents that often accompany the Child Care Provider form.

  • Background Check Authorization Form: This document is necessary for obtaining permission to conduct a background check on the provider, any household members over the age of 16, and any other individuals who may have unsupervised access to children. Background checks are a key step in the process to ensure the safety and well-being of children.
  • Child Care Health and Safety Training Certification: Proof of completed training sessions is required for child care providers who are not exempt from licensing. It's essential to demonstrate that the provider has taken courses on health and safety, recognizing and reporting child abuse and neglect, and infant/toddler CPR/First Aid.
  • Water Testing Results: For providers not related to all children in care, testing the water supply for lead is mandatory. The results must be submitted with the Child Care Provider Listing Form, ensuring that the environment is safe for children.
  • First Aid and CPR Certification: This document is proof that the provider has completed the necessary training to respond to emergencies. It is vital for ensuring the provider can offer immediate care in the event of an accident or sudden illness.

In addition to these documents, it's important for providers to keep records organized and accessible. Staying informed about any updates to requirements or additional documentation needed for specific situations can also help ensure a smoother process. Providers should consult with their local Child Care Resource and Referral office or the Direct Pay Unit for specific questions and further guidance.

Similar forms

The Oregon Dhs Child Care Provider form is quite similar to a Family Child Care Home Licensing Application. Both documents require providers to supply detailed information about their services, the environment in which the care is provided, and compliance with specific health and safety standards. They ensure that care providers meet the necessary legal requirements to offer childcare services either within their home or the child's home, focusing on creating a safe and supportive environment for children.

Comparable to the Oregon Dhs Child Care Provider form, an Employee Background Check Consent Form is another document that is necessary for ensuring the safety of children in care. Both documents involve procedures to scrutinize the background of individuals who will have close contact with children, although the background check consent form is specifically focused on gaining authorization to conduct criminal and other relevant checks on potential employees or volunteers within the childcare setting.

A Child Care Enrollment Form shares similarities with the Oregon document in terms of gathering essential information about the children who will be receiving care. Both forms are initial steps in the process of establishing a care arrangement, but the enrollment form is more focused on the child's personal details, health information, and emergency contacts, aiming to ensure that the childcare provider is fully informed about the children’s needs and how to best meet them.

The Child Care Subsidy Application is another document akin to the Oregon DHS form, with both playing crucial roles in facilitating access to affordable childcare for qualifying families. They involve the collection of detailed information to assess eligibility for financial aid towards child care expenses. While the subsidy application is targeted towards parents or guardians seeking assistance, the provider form is more focused on the providers themselves, ensuring they meet state standards to receive funding.

Similarly, the Child Incident Report Form is an essential document in childcare settings, closely related to the safety and health focus of the Oregon Dhs Child Care Provider form. While the Oregon form includes provisions to ensure a safe environment that meets regulatory requirements, the incident report form is used post-factum to document any accidents or incidents within the childcare setting, promoting accountability and continual improvement of safety practices.

The Child Care Program Plan is akin to the Oregon form as it outlines specifics of the childcare environment and program offerings. However, the program plan delves deeper into the curriculum, daily schedules, and educational objectives, showcasing the provider's approach to fostering development and learning. Both documents, though different in focus, aim to showcase the quality and comprehensiveness of the care provided.

The Pre-licensing Inspection Checklist for Child Care Providers mirrors the Oregon Dhs Child Care Provider form in its emphasis on compliance with health and safety standards. This checklist is a tool used by authorities to confirm that childcare facilities meet the regulatory requirements before being granted a license to operate. Both documents are pivotal in the licensing process, ensuring that childcare settings are safe, healthy, and conducive to children's well-being.

Training Verification Forms for Child Care Staff are comparable to the training sections within the Oregon document. Both sets of documents verify that childcare providers and their staff have completed mandatory training programs, such as CPR, first aid, and child abuse recognition. This ensures that everyone involved in the care of children has the knowledge and skills necessary to provide a safe and nurturing environment.

Lastly, the Water Safety Compliance Form for Child Care Providers can be paralleled to the Oregon DHS form's requirement for water testing in non-relative care situations. Both documents highlight the importance of ensuring a safe and healthy environment for children by mitigating risks associated with lead exposure from drinking water, showcasing the meticulous approach taken towards health and safety in childcare settings.

Dos and Don'ts

When completing the Oregon DHS Child Care Provider form, individuals find themselves maneuvering through an essential process that not only affects their professional standing but also the safety and well-being of children under their care. Ensuring the process is approached with diligence is paramount. Here is a compiled list of dos and don'ts to guide through this crucial task:

  • Do contact your local Child Care Resource and Referral (CCR&R) office if you need help filling out the form. Assistance is available, and utilizing it can ensure accuracy and completeness.
  • Do carefully determine your license status. It's crucial to know whether you are providing license-exempt non-relative or relative care, or if you are required to be licensed by the Office of Child Care (OCC).
  • Do complete the required trainings before submitting your Child Care Provider Listing Form. This includes Introduction to Child Care Health & Safety training, Recognizing and Reporting Child Abuse and Neglect, and Infant/Toddler CPR/First Aid training.
  • Do use black or blue ink when filling out the form to ensure that it is legible and formal, aligning with the expected submission standards.
  • Do mail the completed form within 30 days from the date issued in the “ODHS branch use only” section to ensure timely processing.
  • Don't neglect water testing requirements if you are not related to all children in care. Ensuring the safety of the children’s environment is a critical responsibility.
  • Don't overlook the importance of attaching copies of certifications or test results if these are required components of your application. This includes your “Infant/Toddler CPR/First Aid Card” and water sample results for lead testing.
  • Don't ignore the required background checks for everyone in the household age 16 or older, and any other individuals who might have unsupervised access to the children.
  • Don't hesitate to report any changes to the Direct Pay Unit (DPU) as specified, including new arrests, change of address, or any alterations in your licensure status. Timely communication is key to maintaining transparency and trust.

Completing and submitting the Oregon DHS Child Care Provider form is a responsibility that encompasses thorough preparation, attention to detail, and an acute awareness of the regulations governing child care provision. By adhering to these guidelines, providers not only comply with legal requirements but also contribute to a safe and nurturing environment for the children they serve.

Misconceptions

When navigating the complex landscape of child care assistance in Oregon, understandably, there are misconceptions regarding the Oregon Department of Human Services (DHS) Child Care Provider form. Here are five common misunderstandings clarified for better comprehension.

  • Misconception 1: The form solely determines if a provider needs to be licensed.

    While it's true that the form includes a section to help determine licensing requirements, it’s a comprehensive document used by ODHS to gather information on providers to assess their eligibility for subsidy payments and ensure they meet state standards. Licensing is a complex assessment that may require additional steps beyond this initial form.

  • Misconception 2: Completing the form automatically enrolls providers in the subsidy program.

    Completion and submission of the form is a step in the process but does not guarantee enrollment in the subsidy program. Providers must meet all ODHS standards and requirements, including completing specific trainings and passing background checks. The form starts the review process, but ODHS approval is needed for subsidy payment eligibility.

  • Misconception 3: Online CPR training satisfies all provider requirements.

    The document specifies that strictly online CPR training is not acceptable for license-exempt non-relative care providers. This requirement aims to ensure that caregivers have practical, hands-on training to respond to emergencies, reflecting the importance of comprehensive preparedness in child care.

  • Misconception 4: License-exempt providers do not need to undergo background checks.

    Both relative and non-relative license-exempt providers must undergo FBI fingerprint background checks. The requirement underscores the state’s commitment to child safety, ensuring that all individuals involved in child care, regardless of licensing status, are thoroughly vetted.

  • Misconception 5: The form is a one-time submission without the need for updates.

    Providers are required to report any changes, including new arrests, convictions, or involvement with protective services, as well as changes in licensing status or care environment, within five days. This requirement ensures that provider information remains current, reflecting changes that might affect their eligibility or the quality of care provided.

Understanding the nuances of the Oregon DHS Child Care Provider form is essential for providers seeking to navigate the state’s child care system effectively. Clarifying these misconceptions helps streamline the process, ensuring that both providers and the families they serve can achieve the best possible outcomes.

Key takeaways

Filling out and using the Oregon DHS Child Care Provider form requires attention to detailed instructions and compliance with various training and safety standards. The following are key takeaways to guide you through the process:

  • Child care providers must determine their licensing status with the Office of Child Care (OCC), as some may be exempt from licensing under specific conditions, such as relation to the children in care or the frequency and setting of care provided.
  • License-exempt non-relative care providers are required to complete specific trainings, including Introduction to Child Care Health & Safety, Recognizing and Reporting Child Abuse and Neglect, and Infant/Toddler CPR/First Aid. Not all training can be completed online; for instance, strictly online CPR training is not acceptable.
  • Providers caring for children not related to them must test their water supply for lead in any plumbing fixture used for drinking, preparing food, or formula. A copy of the water sample results must be submitted with the Child Care Provider Listing Form.
  • The form must be completed using black or blue ink and mailed, faxed, or emailed (in PDF format) to the Direct Pay Unit (DPU) within 30 days from the date issued.
  • OCC must conduct a home or facility visit to ensure it meets all health and safety requirements as stipulated by OCC and ODHS before a provider is approved.
  • Background checks, including FBI fingerprint checks, are conducted for license-exempt providers, household members aged 16 or older, and any visitors who may have unsupervised access to children in care.
  • Licensed child care providers are required to meet specific ODHS provider requirements and health and safety standards.
  • The Oregon Department of Human Services (ODHS) assists with child care costs for eligible families, but providers must meet all ODHS standards and provider requirements to receive payment.
  • Child care providers are required to report any changes, such as new arrests, convictions, changes in licensing status, and any new people living in or visiting the care location, to the Direct Pay Unit (DPU) within five days.
  • For assistance with the form, providers can contact Child Care Resource and Referral (CCR&R) Centralized Coordination, 211info, or relevant unions for license-exempt and OCC licensed providers.

It's crucial that child care providers carefully read and follow all instructions on the form and complete required trainings and checks to ensure compliance and eligibility for ODHS child care payments. Providers should also stay informed about their responsibilities and the resources available to them.

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