Dear Parent: Workforce Solutions Child Care Services (CCS) Eligibility Requirements 956.687.1121 (Local Calls) 1.877.687.1121 (Long Distance) If you need assistance in paying for daycare and meet the basic eligibility requirements listed below, please contact CCS immediately so that we may process your child care. Household requirements: Parents must be employed, in school or in training A minimum of 25 hours per week for a single parent A minimum of 50 hours per week for a two parent household Household must meet income guideline for family size (see income guidelines below) Documents for you and all household members: Birth Ce cates Social Security Cards (Optional - SSN is voluntary and not a requirement to receive Child Care Services) Driver License for parents If employed: Copies of last (4) four checks stubs for each parent in the household Veri ca n of Work Schedule Household income: Proof of all other household income/bene ts (i.e., Unemployment, Temporary Assistance for Needy Families) If training: Current school schedule and current transcript. If a ending high school/ged program or a Voca onal school, a current le er of enrollment from your school. Veri ca n of School or Training Schedule Compliance with Parent Responsibility Agreement Child Support: If you have an a ve child support case with the O ce of A orney General (OAG), you must provide proof that your case is open along with a copy of the payment history, or provide documenta on from OAG that your case was suspended or closed. If you have your CIN number, you may use it to print your child support information from the Attorney General s website https://childsupport.oag.state.tx.us If receiving Parental Contribu on: Complete the Parent Responsibility Agreement Informal Child Support Form. INSTRUCTIONS: You can mail, fax, or drop off required documents to one of the following o ces. WFS Mission Office 901 Travis St., Suite 7 WFS Weslaco Office 1600 N. Westgate, Suite 400 Mission, Texas 78572 Weslaco, Texas 78599 956.519.4300 956.969.6100 Fax Number: 1.866.580.6089 Fax Number: 1.866.890.5452 Once we receive your informa n, a CCS Advisor will contact you to process your child care. Please make sure to provide us with your home, work, school, cell and any other phone number where we can contact you. Thank you. Eligibility Code Card for Child Care Services E ec ve October 1, 201 through September 30, 201 Family Size Monthly 85% SMI 2 $3, 3 $3, 4 $4, 5 $5, 6 $6, 7 $6,3 8 $6, 9 $6, 10 $6, 11 $6, 12 $7, 13 $7, 14 $7, 15 $7,
Eligibility Packet Guide Checklist Please use this checklist as a guide to help you complete the eligibility renewal packet. All of this information may be mailed, faxed or dropped off to our office. You may go to your nearest Workforce Solutions Center to use a computer, printer or fax machine free of charge. For assistance and/or to locate the WFS Office nearest you, please call (877) 687-1121 or visit. RETURN ALL FORMS TO CHILD CARE SERVICES (CCS) BY THE DEADLINE INDICATED ON THE COVER LETTER. FAX: (WFS Weslaco Office) 1.866.890.5452 or (WFS Mission Office) 1.866.580.6089 Mail or Drop Off: WFS Weslaco Office WFS Mission Office 1600 N. Westgate, Ste. 400 901 Travis St., Suite 7 Weslaco, Texas 78599 Mission, Texas 78572 956.969.6100 956.519.4300 1.877.687.1121 (Toll Free) Parents Guide to Child Care Services Overview Please read this form and keep for your records. Frequently Asked Questions Please read this form and keep for you records. Child Care Eligibility Certification Form This form is your official certification document. By completing this form, you are certifying that the information on this form is complete and accurate. If this form is not complete and accurate child care assistance will not be authorized or may be denied. You must ensure that this document: Does not have any white out corrections. Is NOT written in pencil but in BLUE or BLACK ink Has all information that is applicable, completed Is signed and dated (date should be the day you submit the application) All income, school and training verification must be current Parent Acknowledgment of Rights and Responsibilities This form details what you rights and responsibilities are while receiving assistance. Please make a copy and keep for your records. It outlines: Your rights and responsibilities Your reporting of changes responsibilities and consequences for not reporting changes with in 10 days of occurrence. Fraud and Abuse of program services regulations Attorney General Verification of Child Support Necessary if you do not have an informal arrangement with the non-custodial parent Texas law requires that anyone who receives child care assistance through certain funds must be actively pursuing child support, have all children under 18 years of age attending public school as required by the Texas Education Agency, and parents not abusing illegal substances. If you do not have an informal arrangement with the non-custodial parent (see below), Child Care Services must have verification that you have applied or a print out of your case history for each child. The Office of the Attorney General has an interactive parent portal that allows you to apply online and print off your payment information. The website is www.oag.state.tx.us. If you do not have an open case with the Texas Attorney General s office, then you may provide a copy of one of t he following documents: Child Support through a private agency we must have a printout from that agency that shows a current child support payment history for each child. Confirmation of Child Support Interactive Print Screen If you have an informal agreement with the non-custodial parent, please see Informal Child Support Agreement Form. Orientation to Complaint Form This form provides the parent with an orientation on complaint procedures. Please sign and date form Informal Child Support Agreement Form please find the enclosed form titled Parent Responsibility Agreement/Informal Child Support Form Please make copies of this form, if necessary. Both the custodial AND non-custodial parent of EACH child are required to sign and date this form and return to us. Again, each non-custodial parent must sign and document the payment history. Please Note: Child Support does not have to be a monetary/financial amount; it can be any contribution that the non-custodial parent is providing for the welfare of the child. Verification is required. Note: You do NOT have to return if you have an open child support case with the office of the Attorney General or you have applied.
Parents Guide to Child Care Services Overview Applying For Child Care Services Your Rights: You have the right to have someone represent you. You may ask for help when you apply for child care services. You may ask for help nding out what quality child care is. You may trust that the informa on you give us is con d Your Responsibilities: You must meet the income limits for your family size. You must be in an edu onal program, job training, or employed a minimum numbers of hours per week to be eligible for these services: Single parents 25 hours, two-parent family 50 hours. You must be able to prove zenship and age for the children receiving assistance. You must meet all the requirements as outlined in the Parent Responsibility Agreement. This includes child support for each child living in your household, acceptable public school a endance, and not abusing illegal substances. Note: Must be in compliance at the Eligibility Renewal (recertification) You must live in Hidalgo, Willacy or Starr Coun es. You must provide income veri ca on or veri ca on of enrollment in school or training. You must provide the informa on we request to help us determine your eligibility for child care services You must sign the forms we ask you to sign You must return all requested forms by the deadline date we ve provided Enrolling Your Child Your Rights: You have the right to use any regulated child care provider or an eligible rela ve provider. You may and should visit the child care provider before you decide where you want your children to go Your Responsibilities: You are responsible for the quality of care from the provider you choose. You must call us at least 5 days before transferring your child to a di erent child care provider.
Using a Child Care Provider Your Rights: You may request to move your child to a di child care provider. You may visit your child any me during the day. Your Responsibilities: You must follow our rules and the child care provider rules or your child care services will end. You must respect the provider s star ng and closing hours and pick up your child on me If your child rides a bus to and from child care you or someone else must be at home when the bus picks up or brings home your child You must report any safety or health problems at the child care provider that could harm the children in care to the Department of Family and Protec ve Services (800-582-6036) If Your Child Is Absent From Care You must call the child care provider when your child will be absent and state the reason for the absence. Report absences or ill days to CCAA 1-866-968-6496 Your child is only allowed to be absent/non swipes for 45 days in a 12 month period Your child s care will end if your child is absent for 5 or more days of care in a row and you do not call the child care provider during that me to explain why your child is absent. Paying Your Child Care Fees You must pay the fees in advance, directly to the child care provider, before receiving child care. Any child care help that you receive from another agency must be reported to Child Care Services The fee you must pay for child care is based upon household income and the number of children receiving assistance The child care fee must be paid, even when your child is absent You must pay any over me charges you are billed due to picking your child up late at the child care provider. if the child care provider is closed, you must pay for holiday child care yourself if you do not pay child care fees, your child care services will end. How to Contact Us Child Care Services WFS Mission Office 901 W. Travis Road, Ste. 7 Mission, TX 78572 Tel:956-519-4300 FAX: 1.866.580.6089 WFS Weslaco Office 1600 N. Westgate, Suite 400 Weslaco, TX 78599 Tel:956-969-6100 FAX: 1.866.890.5452
Website: www.wfsolu ons.org An equal opportunity program. Auxiliary aids and services are available upon request to individuals with disabili es. For TTD/TTY, please call Relay Texas 7-1-1 Failure to report changes will result in the termination of your child care assistance, and you will be responsible for paying back any funds used during this time. This could results in suspected fraud, and additional fact finding to determine if misuse of funds has occurred. Le ng Us Know About Changes Your Rights: We will advise you in ng at least 15 days before your child care services end or are reduced (excep ons include CPS and Workforce Customers.) if funding is limited, your child care may end at any me. You will receive a 30 day no ce prior to ending of care. You may appeal when child care is ended, denied or reduced. We will inform you of how to appeal the ac on JOB LOSS: you have the right to receive a maximum of 28 days to search for employment during a 1 year period (October thru September) if the job loss is reported within 10 days of losing your job Your Responsibilities: You must tell us and the child care provider when you change your address, your telephone number where to contact you in an emergency or if your child care schedule changes. You must report any changes to us with in 10 calendar days from when it happens. If you do not report changes, your child care services will end o A new job, a lost job, or a change in job o A pay raise or other new income o Family changes such as marital status, add onal children, et o Loss of tanf ben o A change in school or training o Any other change in your life which could change your eligibility JOB LOSS: You must contact us within 10 calendar days from the date of job loss in order to be eligible for child care during that me. Please contact your nearest Workforce Solu ons Center for assistance in lo g employment. You must recer y your case informa on with us, showing that your family con nues to be eligible for assistance. You cannot change your child s care provider un you talk with us and have been approved for the transfer. We must tell the provider that you are changing child care facili es, and make sure the parent fee is paid in full.
WFS Mission Office WFS Weslaco Office 901 W. TRAVIS ST., SUITE 7 1600 N. WESTGATE, SUITE 400 MISSION, TEXAS 78572 WESLACO, TEXAS 78599 956.519.4300 956.969.6100 FREQUENTLY ASKED QUESTIONS Who qualifies for Child Care Assistance? Anyone living in Hidalgo, Starr or Willacy County, meeting the income guidelines and working, attending school or enrolled in a training program or doing a combination of both for at least 25 hours a week for a single parent and 50 hours a week for a two parent household can qualify for Child Care Assistance. If I am eligible for Child Care Assistance, will I have to pay part of the child care costs myself? Yes, depending on your monthly employment income before taxes (gross amount) and total household income which may include but is not limited to: Child Support, TANF, etc. as well as your family size. You will be responsible for your parent share of cost also known as your co-pay. How do I apply? You can complete the attached packet and either fax or drop off at one of the following centers. West Hidalgo Workforce or East Hidalgo Workforce Fax: 1.866.580.6089 Fax: 1.866.890.5452 How do I choose the right child care? We are a provider choice program where parents have the option to choose their own provider. You can refer to the Consumer Guide brochure located in your packet for more information. If you would like assistance in choosing a provider please visit http://www.dfps.state.tx.us/childcare/about child care Licensing/. You can also call 2-1-1 for further information. Please keep in mind that provider must be licensed or registered with the State of Texas or can be an eligible family member.
Do I have to pursue child support from the father/mother of my child (ren) if s/he does not reside with us? Yes. One of the requirements to be able to receive assistance is that you must be actively seeking child support for all of your children living in your household under the age of 18. You must have an open case with the Attorney General s O ce or an Informal Child Support agreement with the non-custodial parent if they are contributing to the welfare of the child (ren) on a monthly basis. I am having trouble paying my co-payment, are there options available to assist me? Fee reductions are available for unexpected expenses. You will need to provide receipts, invoices, or other documents to support your unexpected expense and a CCS Specialist will determine approval. I lost my job but I am currently seeking employment. Would I still be eligible to receive assistance? You will have to report your job loss within 10 calendar days of the last day of employment. We offer child care assistance while seeking employment for up to 28 days. We offer one job search per year. For more information please contact CCS at West Hidalgo Workforce at 956.519.4300 or East Hidalgo Workforce at 956.969.6100. I am about to have a new baby! Do I need to report my new baby before or after I go on maternity leave from my job? You will need to report your change within 10 calendar days from the last day you worked to request an Incapacitation. We offer 60 days for a medical leave but you must send in medical documents from your doctor and your employer verifying dates of your absence and date you are expected to return to work.
Who can be included in the total number of person in my household? The number of person in your household includes yourself and your dependants under the age of 18 or dependent that you have legal custody of that are attending school, your spouse, or the other father or mother of the children o Note: a dependent can be defined as anyone that you are legally able to claim on your tax return How is my co-pay determined? Your monthly co-pay amount is determined by your monthly employment income before taxes(gross amount) and total household income which may include but is not limited to: Child Support, TANF, etc. as well as your family size and number of children receiving care. Are my rent, electricity, car note, and other expenses taken into consideration when determining my co-pay? Unfortunately no. Your co-pay is based solely on your monthly employment income before taxes (gross amount) and total household income which may include but is not limited to: Child Support, TANF, etc. as well as your family size and the number of children receiving care.
TWIST ID#: CHILD CARE ELIGIBILITY CERTIFICATION FORM 1.Applicant Name (First, MI, Last) / Nombre: (Inicial, apellido) Social Security (optional) / Número de seguro social (opcional) Date Of Birth / Fecha de nacimento Physical Address / Dirección del Domicilio City / Ciudad: Zip Code / Código postal County / Condado Mailing Address / Dirección postal City / Ciudad Zip Code / Código postal Sex: M F Sexo M F Home Phone # / Teléfono del hogar Cell Phone # / Teléfono celular Other Contact # w/name and Relation / Teléfono alternativo, nombre y relación: Are you a Veteran or Spouse of a Veteran? Yes No Es usted es veterano o esposo/a de un veterano? Si No E-Mail Address / Correo Electrónico Foster Youth Yes No Hijos adoptivos Si No Marital Status: ( ) Married ( ) Single ( ) Divorced ( ) Separated ( ) Widowed Migrant Yes No Migrante Si No Food Stamps Yes No Highest Grade Completed / Nivel de educación Family Size Número de miembros que componen la unidad familiar: Race / Raza Estado civil: ( ) Casado ( ) Soltero ( ) Divorciado ( ) Separado ( ) Viudo ( ) 2.Name of Second Parent in Household / Nombre del segundo padre que está en casa Recibe estampillas? Si Other Household Members / Otros Miembros Del Hogar No Social Security # (optional)/ Número de seguro social (opcional) Date of Birth / Fecha de nacimento Name(s) Please write in name as shown on social security card Nombre(s) Por favor, escriba el nombre como se indica en la tarjeta de seguro social Relation Relación Birth Date Fecha de Nacimiento Sex Sexo Ethnicity Raza Social Security# (optional) Número de Seguro Social (opcional) Child Care Requiere cuidado? Child with Special Needs Es niño(a) con necesidades especiales? 3. M F Y/SI No Y/SI No 4. M F Y/SI No Y/SI No 5. M F Y/SI No Y/SI No 6. M F Y/SI No Y/SI No 7. M F Y/SI No Y/SI No 8. M F Y/SI No Y/SI No 9. M F Y/SI No Y/SI No ( ) Workers Compensation / Compensación a los Trabajadores $ Other Household Income (include monthly amount) / Otros Ingresos al Hogar (Cantidad Por Mes) ( ) Child Support / Manutención de Hijos $ ( ) Social Security Benefits (SSA) / Beneficios de Seguro Social $ SSI Y/SI No Y/SI No Y/SI No Y/SI No Y/SI No Y/SI No Y/SI No Grade School Grado Escolar ( ) Veteran s Benefits / Beneficios de Veterano $ ( ) Supplemental Security Benefits (SSI) / Beneficios de Seguro Suplementario (SSI) $ ( ) Unemployment Compensation / Desempleo $ ( ) TANF $ ( ) Other / Otro: $ Day Care Name: DC License #: Phone Number: Nombre de Proveedor Numero de Licencia Numero de Teléfono Applicant Signature / Firma Del Solicitante: Date / Fecha:
TWIST ID#: CHILD CARE ELIGIBILITY CERTIFICATION FORM Employment / Education / Training Empleo / Educación / Entrenamiento Employer Name / Nombre del empleador & Start Date / Fecha Que Empezó Empleo Employer Address/ Dirección del empleador Job Title / Position / Puesto de trabajo/cargo & Pay Rate / Sueldo por hora Employer Telephone Number Número telefónico del empleador Hours Worked per Week & How Often Paid / Horas trabajadas por semana y con qué frecuencia se le paga Employer Name #2 / Empleado # 2 Nombre del segundo empleador (si aplica) Start Date / Fecha Que Empezó Empleo Employer Address Dirección del segundo empleador Job Title / Position Puesto de trabajo/cargo & Pay Rate / Sueldo por hora Employer Telephone Number telefónico del segundo empleador & Número Hours Worked per Week & How Often Paid / Horas trabajadas por semana y con qué frecuencia se le paga Name of College / School / Training Program Nombre del colegio / escuela / programa de capacitación? College Credit Hours Currently Attending / Horas de crédito Universitario que asiste actualmente College Semester Hours Completed to Date / Horas Universitarias semestre completado hasta la fecha Name of Other School or Training Program / Nombre de la segunda escuela o programa de capacitación Any Degrees or Certificates Currently Obtained (Associates, Bachelors, or Certificates) Tiene algún título académico o documento ya adquirido? (Diplomado, licenciatura, etc) *Self Employed / Type of Business *Negocio propio / Tipo de negocio Applicant s Information Información del Solicitante Second Parent in HH Information Información del Segundo Padre (si está en el hogar) Provide verification for the following ítems for each member of the family, if applicable Proporcione verificación para lo siguiente. para cada miembro de la familia, si es aplicable Gross Wages/Salaries Ingresos Brutos/Salarios Self-Employment Reg Payments SS Act Reg. Wkm Compensation Comp & Disability Payments Interest/Dividends Railroad Retirement Retirment Other Included Income Child Support SSDI Public Assistance Unemployment Benefit Capital Gains/Loses One Time Cash Payment Pago Veterans Active Duty Payment in lieu of TANF Payment from Home Sales Auto Accident Payment Lottery Winnings $600 or greater Pensions, annuities, life insurance and 401K withdrawlas Trabajo por cuenta propia Pagos Reg. Del Seguro Social Compensación Reg. Del Trabajador Pago de Comp. Por Incapacidad Intereses/Dividendos Jubilación Ferroviaria Jubilación Otro Ingreso Incluido Sostenimiento pare Niños Seguro Social *Self-employed customers must complete and submit F1049 with receipts, if applicable along with required self-employment documentation. *Los clientes autónomos deben completar y enviar F1049 y presentar con recibos, si se aplica junto con la documentación requerida autoempleo. Asistencia Publica Compensacion de Trabajadores Ganancias Capitales/Perdidas Pago en Efectivo una sola vez Veteranos de Servicio Activo TANF Pago en lugar de TANF Pago por Venta de Casa Pago debido a Accidente Automotriz Premios de Lotería de $600 o mas Pensiones, anualidades, seguro de vida, plan dejubilicion y retiros de 401K I understand that: (1) a person who obtains or attempts to obtain, by fraudulent means, services to which the person is not entitled may be prosecuted under applicable state and federal laws; (2) I am entitled to be notified about my eligibility for services within 20 calendar days from the date of this application; (3) I, or my representative, may appeal denial, reduction, or termination of services; (4) services will be provided without regard to sex, race, creed, color, national origin, or disability; (5) the information on this application is confidential. By signing this form, I am applying for services from Workforce Solutions or their child care contractor. I give permission to Workforce Solutions or their child care contractor to contact a third party to verify income or family size, and use the social security numbers for identification of Social Security Benefits and income. All Information provided represents a complete and accurate statement of my family s circumstances at the time of application. I agree to report any changes to this information within 10 business days of the change. I understand that social security numbers (SSN) are voluntary and not a requirement to receive child care services. Entiendo que (1)Personas que obtienen o que atentan obtener, por medio ilícito, servicios a personas que no califican pueden ser demandadas bajo las leyes federales y estatales; (2) Tengo el derecho de recibir notificación de mi elegibilidad de servicios dentro 20 días calendarios a partir de la fecha de esta aplicación; (3) Yo, o mi representante, pueden apelar el rechazo, reducción o terminación de servicios; (4) servicios serán dados independiente de raza, sexo, credo, color, nacionalidad, o incapacitación; (5) la información en esta aplicación es confidencial. Al firmar esta forma, estoy aplicando para los servicios de Workforce Solutions o el contratista de cuidado de niños. Le doy permiso a Workforce Solutions o al contratista de cuidado de niños que contacten a terceros para verificar ingresos o la cantidad en la unidad de familia, y el uso de los números sociales para identificar ingresos y beneficios de seguro social. Toda la información proporcionada representa una declaración completa y precisa de las circunstancias de mi familia en el momento de la solicitud. Estoy de acuerdo en reportar cualquier cambio a esta información dentro de 10 días hábiles posteriores al cambio. Entiendo que el número social es voluntariado y no es un requisito para recibir servicios de cuidado infantil. Applicant Signature / Firma Del Solicitante: Date / Fecha: CCS Representative / Firma de Representante de CCS: Date / Fecha:
TWIST ID#: CHILD CARE ELIGIBILITY CERTIFICATION FORM ELIGIBILITY DETERMINATION DATA SHEET Customer Name: TWIST Number: Customer Child Care Eligibility Certification Form Date: For Office Use Only --------------------------------------------------------------------------------------------------------------------------------------- Eligibility Dates: Family Size: Gross Monthly Income: Max Allowable Income for Family Size: # Children in Care: Provider Name/ License #/Phone #: Person Receiving Information at DC: Authorization Code: DC Effective Date: Transportation: Care Hours/Days Authorized: Monthly Parent Share of Cost for the 1 st of the Following Month: Parent Share of Cost for the Current Month: Reductions: PT Care - S/C Care - Part Week - Low Income Reduction - Extenuating Circumstance Transitional Dates: Transitional Form on File: 28 Job Search Dates: to Last Job Search Date: Medical Leave Dates: to Documents on File: Education / Training Program with: Start Date: End Date: Were Phone Numbers and Mailing Address Updated In TWIST? Date Form 2450 and Summary Form Mailed: Date PARR/CCAA Form was reviewed with Customer: Data Entry Date: Comments: CCS Rep Signature: Date:
Workforce Solutions Child Care Services IMPORTANT Child Support Information Child Care Services no longer has access to the Office of the Attorney General Web Portal, which allowed our agency to verify your formal child support cooperation on your behalf. Eligibility requirements state that in order for you to be eligible for services you must prove that you are actively seeking child support (formal or informal agreements) for all of your children living in your household under the age of 18. It will be your responsibility to provide verification of compliance with this requirement in order to be considered eligible for child care assistance. If you do not have an informal arrangement with the non-custodial parent, you must: Locate the Office of Attorney General nearest you, apply online, or utilize the interactive child support portal for existing cases. Please go online at www.oag.state.tx.us. Verification of the application or payment history will be required by CCS in order for services to be authorized or re-authorized. Please attach your child support verification here and return to CCS. (Please attach all child support verification documents for all children in household)
PARENT ACKNOWLEDGMENT OF RIGHTS AND RESPONSIBILITES FOR CHILD CARE SERVICES Parent Name: TWIST #: Please read the information on this form carefully before you and your spouse (if applicable) sign and date. Please contact your child care worker immediately if you have any questions regarding the information or requirements on this form. Please understand that this is temporary funding and can end at anytime if you become ineligible or funding has been exhausted. PARENT ENROLLMENT I understand the available child care services, my rights and responsibilities, and the process to receive and continue the child care services. My spouse (if applicable) and I must: Be in training, education or employment activities for at least 25 hours a week for a single family, and 50 hours a week for a two parent household. Be within income guidelines for my family size. Reside within Hidalgo, Willacy or Starr County. Sign, date and submit all required forms and documents to CCS at least 10 work days before my eligibility end date. Report lost of employment within 10 calendar days of occurrence. I understand that I may be eligible for a 28 day job search activity once a year (October to September) (non-applicable for CPS and Workforce Center customers). Select the child care arrangement that my family is using. I was given information about the different type of child care. (Not available to CPS referred parents.) I understand the requirements of the child care facility. I will meet the enrollment requirements of the child care facility. I understand I must report to Child Care Services within 3 business days, instances in which a parent s attempt to record attendance in CCAA is denied or rejected and cannot be corrected at the provider site. Failure to report such instances may result in an absence counted toward the reimbursement to the provider. I understand a fifteen (15) day notification will not be required and child care will not continue during an appeal if the care was terminated due to five (5) consecutive absences and with no parent contact with the provider or child care contractor. I will provide information including health and immunization records, authorization to secure medical assistance, and parent contact information to be used in case of an emergency. I will be on time and honor the child care facilities starting and closing hours. I will pay any charges incurred if I am late picking up my child. I will report to TDFPS licensing office any possible violation of licensing standards within the child care facility. If I need child care on any of the provider s nine paid holidays, I will make and pay for my own arrangements. I will make other child care arrangements when I am no longer eligible for child care services. I understand childcare providers are prohibited from denying a child care referral based on the parent s income status, receipt of public assistance or the child s Texas Department of Family and Protective Services Child Protective Services (CPS) status. I understand providers cannot charge fees to parents receiving child care services that are not charged to parents who are not receiving child care services. I understand I am only allowed up to three provider transfers per year based on anniversary date. Transfers will be effective on the first of the following month. Exception to the transfer limit and effective start date will be allowed due to child safety issues, provider corrective action or other extenuating circumstances. I release the Workforce Solutions-Child Care Services Contractor, Lower Rio Grande Valley Workforce Development (LRGVWD) Board, and Texas Workforce Commission (TWC) from any responsibility for the quality of the child care services my child may receive from the facility of my choosing. Parent Signature: Date: