Maryland Daycare and Child Care Forms

Licensing Forms

Licensing Forms – Fill-in Enabled Versions

Each of the forms listed below can be filled out on-screen by (1) downloading and saving the document to your hard-drive, then (2) opening the document back up and typing the requested information into the gray fields provided next to the items on the form. These forms are “protected” to allow you to move from field to field simply by pressing the TAB key on your keyboard. (NOTE: If you unprotect a form, it will lose this “tab-to-field” ability. To restore that ability, you will need to go to “Tools” on your main toolbar and select “Protect Document.”)

When you have completed the form, you can either print it out and send it to your OCC Regional Licensing Office, or e-mail it to your Regional Licensing Office as an attachment if it does not require an original signature. As a precaution, we recommend that you save the completed form on your hard-drive before printing it out or attaching it to an e-mail.

Important: Some of the forms below require one or more original (i.e., hand-written) signatures. Before you submit a form to your Regional Licensing Office, please make sure that it has all the necessary signatures.

After each form below, one of the the following indicators is used to show what type of child care facility the form is used for:

  • (HOME) – family child care homes
  • (CTR/LOC) – child care centers and letter of compliance facilities
  • (CTR) – child care centers only
  • (LOC) – letter of compliance facilities only
  • (ALL) – centers, homes, and letter of compliance facilities

If you have any questions about the use of a form, please contact your Regional Licensing Office.

Form Number Text/Description

100 Professional Development Plan (CTR)
101A Professional Development Plan-1st Year(HOME)
101B Professional Development Plan-Continuing (HOME)
101C FDC Applicant – Initial Training Requirements (HOME)
349 Application to Resume Service (HOME)
670 Announced Inspection Preparation Checklist – Child Care Centers and Letter of Compliance Facilities (CTR/LOC)
671 Announced Inspection Preparation Checklist – Family Child Care Homes (HOME)
672 Request for Continuing License or Letter of Compliance (CTR/LOC)
673 Request for Continuing Registration (HOME)
1200 Application – Initial (CTR/LOC)
1201 Insurance Information (CTR/LOC)
1203 Personnel List & Staff Change Report (CTR/LOC)
1204 Medical Report for Child Care (ALL)
1205 Personnel Information (CTR)
1206 Staffing Pattern (CTR/LOC)
1209 Changes in Facilities (CTR/LOC)
1213 Variance Request (ALL)
1214 Emergency Form (ALL)
1215 Health Inventory (ALL)
1216 Medication Administration (ALL)
1218 Menu Plan (CTR/LOC)
1229 Substitute Form (HOME)
1230 Application – Initial (HOME)
1260 Release of Information (ALL)
1261 Emergency Escape Plan (HOME)
1267 Provider Information & Plan of Operation (HOME)
1268 Environmental Health Survey (ALL)
1270 Notice of Intent to Operate (CTR/LOC)
1275 Additional Adult Application (HOME)
1281 Request for Hearing (ALL)
1285 Health History – Drop -in (CTR)
1295 Self – Assessment Guide (HOME)

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