Iowa Daycare and Child Care Forms
Forms Guide
http://www.dhs.state.ia.us/DHSForms.html
ADMINISTRATIVE FORMS
Authorization for Release of Information 470-0461
Authorization to Take and Use Photographs 470-0060
Authorization to Take and Use Photographs of a Minor 470-0064
PROVIDERS
Invoice(All Providers)
General Accounting Expenditure GAX
Child Care Assistance Providers
Child Care Provider Claim 470-4466
Child Care Provider Electronic Claim Form
Payment Application for Nonregistered Providers 470-2890
Child Care Assistance Provider Agreement 470-3871
Child Care Assistance Attendance Sheet 470-3872
PROMISE JOBS Child Care Attendance and Invoice 470-3896
Non-Law Enforcement Record Check Request Form A 595-1489
Non-Law Enforcement Record Check Request Form A (Spanish) 595-1489
Facilities
In Home Health Related Care Providers
Provider Health Assessment 470-0672
Statement of Services Rendered 470-0648
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