ࡱ                >  	               t          w          s    	               R   bjbjcTcT                  	 4\  > > g                                                                      .      .  q      q      q      q      q                                          |         }!  .    J                            *    ,                                                       "    M%  \      i                   q                                                                   q      q                         7!     H      H      H        
   q            q                           H                                                                           H              H                                                                              H                PDl                   H                    M!  0   }!      H      %      L    %      H                                                                              %              q      H  p              H                                                                                                                  H                                                        }!                                                                                                                  %                                                                                                                    .  	  7  :     	                                                                                                                                                                                                                                                                                                                                                                                                                                        M I S S O U R I   D E P A R T M E N T   O F   S O C I A L   S E R V I C E S  C H I L D   C A R E   P R O V I D E R   R E Q U E S T   F O R   I N F O R M A T I O N        F O R M T E X T                   F O R M T E X T               F O R M T E X T              F O R M T E X T               F O R M T E X T               D V N      F O R M T E X T              T h e   i t e m s   c h e c k e d   b e l o w   m u s t   b e   r e t u r n e d   i n   o r d e r   t o   p r o c e s s   t h e      F O R M D R O P D O W N     .     S e n d   t h e   r e q u e s t e d   i t e m s   n o   l a t e r   t h a n      F O R M T E X T           .   C H I L D   C A R E   P R O V I D E R   R E G I S T R A T I O N   A P P L I C A T I O N   A N D   A G R E E M E N T   ( F A 3 5 0 )  C O N T R A C T   F O R   P U R C H A S E   O F   C H I L D   C A R E   ( C M - 5 )      F O R M C H E C K B O X       C o m p l e t e   F A 3 5 0 ,   a greeing to the highlighted statements FORMCHECKBOX  Complete FA350, with provider and/or parent signature FORMCHECKBOX  Legible copy of a photo ID FORMCHECKBOX  Current TB test result FORMCHECKBOX  Copy of current child care license FORMCHECKBOX  A local background screening from  FORMTEXT                                                                                                                                                                                                             .     F O R M C H E C K B O X       C a l l   ( 8 6 6 )   5 2 2 - 7 0 6 7   t o   m a k e   a n   a p p o i n t m e n t   t o   b e                        f i n g e r p r i n t e d     F O R M C H E C K B O X       C o m p l e t e   t h e   a t t a c h e d   C h i l d   C a r e   P r o v i d e r   R e g i s t r a t i o n            B a c k g r o u n d   S c r e e n i n g   R e q u e s t   f o r m   f o r      F O R M T E X T           .      F O R M C H E C K B O X       Complete the Contract for Purchase of Child Care FORMCHECKBOX  Complete the services for which you are licensed to     provide care. FORMCHECKBOX  Complete the contract  with the provider signature and        date FORMCHECKBOX  Complete the contract with license begin and end dates. FORMCHECKBOX  The DHSS license is showing pending or closed.  You           cannot Contract for Purchase of Child Care without a      valid license.CHANGE OF ADDRESSDIRECT DEPOSIT FORMCHECKBOX  Complete attached FA350 in full FORMCHECKBOX  Provide proof of address change (ex. copy of bill, lease     agreement, etc.) FORMCHECKBOX  Complete/sign the Application for Vendor Direct Deposit FORMCHECKBOX  Sign the Application for Vendor Direct Deposit FORMCHECKBOX  Attach a VOIDED check FORMCHECKBOX  Attach a VOIDED savings deposit slip   * If you do not have checks or deposit slips, provide a      letter from your financial institution with the routing     number, account number, and type of account payment      should be deposited.PROOF OF FEDERAL TAX ID FORMCHECKBOX  Copy of social security card FORMCHECKBOX  Federal Tax Identification Number (EIN) on IRS      letterhead      Acceptable forms of proof of your Tax ID include the      following:              * Copy of form 941  Employer's Quarterly                 Federal Tax Return with barcode, or               * Copy of form 8109 Federal Tax Deposit                  Coupon, or                                        P                            纩kS>-       h4F hVH CJ OJ QJ ^J aJ  )j    h4F h{ CJ OJ QJ U^J aJ .j    hvS CJ OJ QJ U^J aJ mH nH u /j:"  h4F h CJ OJ QJ U^J aJ  h4F h{ CJ OJ QJ ^J aJ  )j    h4F h CJ OJ QJ U^J aJ  h:n hVH CJ OJ QJ ^J aJ   h:n h4ZF CJ OJ QJ ^J aJ  h2E hl{ 5OJ QJ ^J h2E hq 5OJ QJ ^J hl{  (j    hy hy CJ UaJ mH nH u     R          	  V	  ~	  	                                      m            g            ^            ^            g            g            g                          	  $If   gdVH   $If      kd!  $$If   l             0 * X %
t  0                                6  4   4 
l a  p                yt2E  
  $@&If   gd2E  
      	  	  	  
	  	   	  "	  ,	  0	  D	  F	  H	  R	  T	  V	  X	  l	  սnսVE                                        h4F h31 CJ OJ QJ ^J aJ  /j#  h4F h CJ OJ QJ U^J aJ /j"#  h4F h CJ OJ QJ U^J aJ  h4F hK CJ OJ QJ ^J aJ   h4F hVH CJ OJ QJ ^J aJ  )j    h4F h CJ OJ QJ U^J aJ .j    hvS CJ OJ QJ U^J aJ mH nH u #j    hvS CJ OJ QJ U^J aJ /j"  h4F h CJ OJ QJ U^J aJ  l	  n	  p	  z	  |	  ~	  	  	  	  	  	  	  	  	  	  ҺҩvdVAd)d        .j    hvS CJ OJ QJ U^J aJ mH nH u )j~$  h CJ OJ QJ U^J aJ h CJ OJ QJ ^J aJ  #j    h CJ OJ QJ U^J aJ  h2E hpd CJ OJ QJ ^J aJ   h2E hl{ CJ OJ QJ ^J aJ   h:n h: CJ OJ QJ ^J aJ   h:n hVH CJ OJ QJ ^J aJ  .j    hvS CJ OJ QJ U^J aJ mH nH u )j    h4F h CJ OJ QJ U^J aJ /j
$  h4F h CJ OJ QJ U^J aJ  	  	  	  	  	  	  
                                                  p            g                                                                                                                	  $If   gdQn    kd$  $$If   l             0 *      
t  0                                6        4   4 
l a  p                yt2E   $If    	  	  	  	  :
  <
  X
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  \
  
  
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  
  
  
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  
  
  
  ը՗tcKt3t        .j    hvS CJ OJ QJ U^J aJ mH nH u /j'  h{ h CJ OJ QJ U^J aJ  h{ h+MN CJ OJ QJ ^J aJ  )j    h{ h CJ OJ QJ U^J aJ hVH CJ OJ QJ ^J aJ   h2E hVH CJ OJ QJ ^J aJ  /j%  h2E hvS CJ OJ QJ U^J aJ )j    h2E h CJ OJ QJ U^J aJ  h2E hpd CJ OJ QJ ^J aJ  hl{  h2E hl{ CJ aJ  h2E hpd CJ aJ 
  
  
              &  '  5  6  7  n  o  }  ~                    ҽ|dL                  /j*  h2E hvS CJ OJ QJ U^J aJ /jr*  h2E hvS CJ OJ QJ U^J aJ /j)  h2E hvS CJ OJ QJ U^J aJ /j)  h2E hvS CJ OJ QJ U^J aJ  h2E h]. CJ OJ QJ ^J aJ  )j    h2E h CJ OJ QJ U^J aJ h2E h-B  #h2E h-B 5CJ OJ QJ ^J aJ hpd   h2E hpd CJ OJ QJ ^J aJ 
  
  b                                                                                                                                                                                                                                                                   $If    p  kd4(  $$If   l             . * +          
t  0                                6              4   4 
l a  p
        yt2E      &  n              Z    i            c            c            c            c            c            c            c            c            c            c                     $If      kd(  $$If   l             0 *                                  	  
t              0                                6                          4   4 
l a  p            yt2E              	  
  -  .  8  9     
        .  0  2    fM5  /j,  h2E hvS CJ OJ QJ U^J aJ 1j    hvS >*CJ OJ QJ U^J aJ mH nH u2jB,  h2E h >*CJ OJ QJ U^J aJ  #h2E h+}% >*CJ OJ QJ ^J aJ ,j    h2E h >*CJ OJ QJ U^J aJ  /j+  h2E hvS CJ OJ QJ U^J aJ  h2E h]. CJ OJ QJ ^J aJ  )j    h2E h CJ OJ QJ U^J aJ /jZ+  h2E hvS CJ OJ QJ U^J aJ                                    1  2  @  A  ٪~eM5  /j.  h2E hvS CJ OJ QJ U^J aJ /j.  h2E hvS CJ OJ QJ U^J aJ 1j    hvS >*CJ OJ QJ U^J aJ mH nH u2j-  h2E h >*CJ OJ QJ U^J aJ  #h2E h$0 >*CJ OJ QJ ^J aJ ,j    h2E h >*CJ OJ QJ U^J aJ  /j*-  h2E hvS CJ OJ QJ U^J aJ  h2E h]. CJ OJ QJ ^J aJ  )j    h2E h CJ OJ QJ U^J aJ      1  w        *  v                                                                                                                                              p                               kd^0  $$If   l             .0 *                              
t  0                                6                          4   4 
l a  p                yt2E   $If    A  B  |  }                                              )  *  +  9  :  ȷꦎ}}}}e}}M/j/  h2E hvS CJ OJ QJ U^J aJ /jr/  h2E hvS CJ OJ QJ U^J aJ  h2E h- CJ OJ QJ ^J aJ  /j.  h2E hvS CJ OJ QJ U^J aJ  h2E hc CJ OJ QJ ^J aJ   h2E hF6 CJ OJ QJ ^J aJ   h2E hd CJ OJ QJ ^J aJ   h2E h]. CJ OJ QJ ^J aJ  )j    h2E h CJ OJ QJ U^J aJ  :  ;                          *  +  ,  N  R  k  l  }  ~  t\K:   h2E hrK] CJ OJ QJ ^J aJ   h2E hI CJ OJ QJ ^J aJ  /j@2  h2E hvS CJ OJ QJ U^J aJ /j1  h2E hvS CJ OJ QJ U^J aJ  h2E hF4[ CJ OJ QJ ^J aJ  #h2E h]. 5CJ OJ QJ ^J aJ #h2E hF4[ 5CJ OJ QJ ^J aJ h2E h].   h2E h]. CJ OJ QJ ^J aJ   h2E hc CJ OJ QJ ^J aJ  )j    h2E h CJ OJ QJ U^J aJ            f  |  }      0  g                          a                                                                                                                  kd1  $$If   l             0 *                                  	  
t              0                                6                          4   4 
l a  p            yt2E   $If    ~                        	        #  )  0  1  ?  @  A  K  Q  g    p^F^           /j4  h2E hvS CJ OJ QJ U^J aJ #h2E hF4[ 5CJ OJ QJ ^J aJ /j3  h2E hvS CJ OJ QJ U^J aJ /j,3  h2E hvS CJ OJ QJ U^J aJ  h2E h+}% CJ OJ QJ ^J aJ   h2E hHX CJ OJ QJ ^J aJ  )j    h2E h CJ OJ QJ U^J aJ /j2  h2E hvS CJ OJ QJ U^J aJ  h2E hF4[ CJ OJ QJ ^J aJ g  l  5  6  O  P  Q  R  `  a  b  c                 <  <  <  <  ׮q\qD\qBqq                  U/jt6  h2E hvS CJ OJ QJ U^J aJ )j    h2E h CJ OJ QJ U^J aJ  h2E h< CJ OJ QJ ^J aJ  2j5  h2E hvS 5CJ OJ QJ U^J aJ  #h2E h< 5CJ OJ QJ ^J aJ ,j    h2E h 5CJ OJ QJ U^J aJ  #h2E hF4[ 5CJ OJ QJ ^J aJ h2E hF4[   h2E hF4[ CJ OJ QJ ^J aJ   h2E h+MN CJ OJ QJ ^J aJ g        4  5  6  N  O  P                                                              o                                                                                                                   kd4  $$If   l 4            0 *               `                
t  0                                6                          4   4 
l a  p                yt2E   $If    	P  Q            V        <  l            f            f            f            f            f            f            f            f            f            f                           $If     kdD5  $$If   l 4            0 *                                  	 
t  
      0                                6                          4   4 
l a  p              yt2E                              *   C o p y   o f   l e t t e r   1 4 7 c   ( t h i s   l e t t e r   m a y   b e   o b t a i n e d                                    f r o m   I R S ) .         F O R M C H E C K B O X       O T H E R       F O R M T E X T             C H I L D   C A R E   V E N D O R   I N V O I C E        F O R M C H E C K B O X       D a i l y   A t t e n d a n c e   R e c o r d s   m u s t   b e   a t t a c h e d   t o   i n v o i c e     F O R M C H E C K B OX  Sign the invoice and/or the attendance records FORMCHECKBOX  Parent must sign/initial the attendance records FORMCHECKBOX  Complete the Daily Attendance Record FORMCHECKBOX  Complete the Child Care Vendor Invoice FORMCHECKBOX  Resolve discrepancies in the Child Care Vendor Invoice     * The invoice does not match the submitted attendance        records.IF YOU HAVE ANY QUESTIONS OR NEED MORE INFORMATION, CONTACT:PROVIDER RELATIONS REPRESENTATIVE FORMTEXT                     <  <  <  <  <  <  <                                      f                                                                                                                                        kd6  $$If   l 4            0 *`                               
t  0                                6                          4   4 
l a  p                yt2E 	  $If   gd<   $If    <  <  <  <  <  <  <  <  <  <  <  =  =  =  =  =  =   =  V=  X=  Z=  \=  x=  ѿѿgO                                            .j    hvS CJ OJ QJ U^J aJ mH nH u /j8  h2E h CJ OJ QJ U^J aJ  h2E h/ CJ OJ QJ ^J aJ  )j    h2E h CJ OJ QJ U^J aJ 2j7  h2E hvS 5CJ OJ QJ U^J aJ  #h2E h< 5CJ OJ QJ ^J aJ ,j    h2E h 5CJ OJ QJ U^J aJ   h2E h< CJ OJ QJ ^J aJ  h2E h< <  <  <  =  f            `            W                                                                                                                                   	  $If   gd75   $If     kd8  $$If   l 4             0 *                                  	   
t                0                                6                          4   4 
l a  p              yt2E  =   =  T=  V=  X=  u            o            o            o                                                                                                                                                                    $If     kdW9  $$If   l 4            0 *               `                
t  0                                6                          4   4 
l a  p                yt2E  X=  Z=  =  5>  w>  >  >  0?  l?  |?  }?  ~?  n            h            h            h            h            h            h            h            h            h            h                               $If     kd:  $$If   l 4            0 *                                  	 
t  
      0                                6                          4   4 
l a  p              yt2E  x=  z=  |=  =  =  >  >  >  5>  6>  D>  E>  F>  T>  `>  w>  x>  >  >  >  >  >  >  >  >  >  >  >  hP                     /j<  h2E hvS CJ OJ QJ U^J aJ /j*<  h2E hvS CJ OJ QJ U^J aJ  h2E hWo CJ OJ QJ ^J aJ  /j;  h2E hvS CJ OJ QJ U^J aJ /j>;  h2E hvS CJ OJ QJ U^J aJ  h2E h< CJ OJ QJ ^J aJ  )j    h2E h CJ OJ QJ U^J aJ /j:  h2E hvS CJ OJ QJ U^J aJ  >  >  >  5?  6?  8?  Q?  U?  s?  t?  z?  {?  ~?  ?  ?  ?  ?  ?  ?  ?  ?  kYGY5  #h2E hvR 5CJ OJ QJ ^J aJ #h2E hf 5CJ OJ QJ ^J aJ #h2E hNH 5CJ OJ QJ ^J aJ 4h2E h< 5CJ OJ QJ ^J aJ fH q
       #h2E h< 5CJ OJ QJ ^J aJ h2E h<   h2E h+}% CJ OJ QJ ^J aJ   h2E h: CJ OJ QJ ^J aJ   h2E h< CJ OJ QJ ^J aJ  )j    h2E h CJ OJ QJ U^J aJ /j=  h2E hvS CJ OJ QJ U^J aJ  ~?  ?  ?  ?  ?  R  R  w            q            q            q            q            q                                                                                                                                      $If     kd=  $$If   l 4            0 *                                
t  0                                6                          4   4 
l a  p                yt2E  ?  ?  ?  ?  ?   @   R  
R  R  R  R  R  R  ,R  .R  0R  Ī֨}vdRC1                   #j    h CJ OJ QJ U^J aJ h%<< 5CJ OJ QJ ^J aJ #h2E h%<< 5CJ OJ QJ ^J aJ #h2E h%<< 5CJ OJ QJ ^J aJ h2E h<  #hv h: 5CJ OJ QJ ^J aJ 1j    hvS 5CJ OJ QJ U^J aJ mH nH uU2j>>  hv h 5CJ OJ QJ U^J aJ  #hv h 5CJ OJ QJ ^J aJ ,j    hv h 5CJ OJ QJ U^J aJ  #h2E h< 5CJ OJ QJ ^J aJ            P H O N E   N U M B E R     F O R M T E X T            D A T E     F O R M T E X T               	 	 	 	 	 	 	 	 	 	 	 	 	 C D - 1 4 8   ( 0 1 / 1 0 )                                                                                                                                                                                                                                                                                                                              R  R  R  .R  VR  `R  R  l            f            ]            ]            f            T                                                                          	  $If   gd:n 	  $If   gd#C   $If     kd>  $$If   l 4             0 *`                                 	 
t  
      0                                6                          4   4 
l a  p              yt2E  0R  DR  FR  HR  RR  TR  VR  ^R  `R  bR  vR  xR  zR  R  R  R  R  ˳ˡn`Knn92                h2E h%<<  #h4F h%<< 5CJ OJ QJ ^J aJ )j?  hxH CJ OJ QJ U^J aJ hxH CJ OJ QJ ^J aJ  #j    hxH CJ OJ QJ U^J aJ h#Y 5CJ OJ QJ ^J aJ #h2E h%<< 5CJ OJ QJ ^J aJ #h:n h:n 5CJ OJ QJ ^J aJ .j    hvS CJ OJ QJ U^J aJ mH nH u #j    h CJ OJ QJ U^J aJ )jl?  h CJ OJ QJ U^J aJ h CJ OJ QJ ^J aJ R  R  R  T            R                                                                                                                                               kd@@  $$If   l 4             F *                  
                 
                	 
t  
      0                                6                                      4   4 
l a  p                      yt2E  R  R  R  R                                                                                                                                                                                                                                                                                                                                                                                                                      h-B hF CJ OJ QJ ^J aJ  h?" CJ OJ QJ ^J aJ  h,LJ CJ OJ QJ ^J aJ 2 1h:pF / =!"#$%                                                                                                                                                                                                                                                                                                                                                                                                                                                                              !  D d                    rr!!                                 j   
      
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
   IHDR   n   n      PLTERRRZZZccckkksss{{cBB{JJs))  9        R   kcs ! 9! Z!1 {)B) ƵcRJ{B)1 ֥9 J R ƜJ kRkZ9c9{1 ZB1{99 ƄJk)Jk ck罔k{Jք1cc ZJZ  BZ9{!Z1 s{Z{cB)ք9! {Z { ֭Ƅ{ΜJ B9)cƌsBkΥRR{Z {R  sε{Μ)BƔ{ J)sƭkcJcΜ  ֔k k{  B9 sc Jֽ { RRBssJ))RRkk  1 { k{ Rk BZ !1  !c ckkBJJsk1!199ZkR{9{kRΌRsB9Rs{Z)kB {sk1Z){!kZ)Rcc{kޥ cR Rc BޔZk!1R)Bs!9k JRZkk{!cZk!BJZ)B 1΄ 9cs1 !祥99J)    1  c       ZJR9kcB{9 RB)BRƥ{9ck 1{ !1ckc)1   1T   bKGD   cmPPJCmp0712   H s  IDAThCz|Sڴgs	@<h=)..@+9QÕuM*TWZI~Nn9U.H7;l>U":kR777{=M5=F^y^;EK(k]-By|\ :ΓL_;R	Q(XSX1]&U.{gJ$.nQ?qHU<|>r}D?+KqSl_Jኙ9lu_FusRn[)N'(÷ѽH\ C{lM ,j2m=<RrKvx'.?6~Κs.
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=&U:d_US0]?D	KVbH^q6I0O9kq%vgYjJw7Lկ>U|;}R*N/^ v!)uBU!rx`,4XWLj;q}#̙<UhWQ8}ÂȅRFƮ	͖!8vt|?'$7.6ގ _lGJ
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qި;T1O7(*Q~-5%'s"!tda%eV`nc!8?hFyۃuZL]6W"jݮJPQmWu.$cR);X;ඬ迍?,qw@IѠZ'L㷋֭^pDjnjPjA%pȭf3V&
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wBWcrM/d鄒A3ՀODLi]=SUnMW1ɞ"	0lsuCT?uτλ_,l@3HG}|ђdS~{ ԭ:lHw8\S]N؁΂ >rX-:ˈ- ~W4Xn	AJE[eRcb]O䚻ӧO1mꌩ].3Gx[-*Q/aY
Tz #O.1H7)Qa#覚mywqgDwӦOuMwE;e#|1ܺV0f7]1%lq7ɞ 4	}'uӳAzZSpXH]5Q?6ݛ5/}$d{2*o^dxHQn^sê4xau+'n<ZܝnbAq23Ÿ26g%ÛߓǪgiŖR4Pq4nRl8
l]ߞHt@}'y Z\ﰳvEи9Ã!`#Qw<O
!GW.i"McXgݫKwĻ{4cڇۮ&FYz
 ZZKaE牤\94Y1<CcvMWW1{:;Qip,\ky*cgg6	mJN=.[&YcDDdM&D_CSRl5uF>i<9Ԟ6?wwy2Lv;rY5A\M#Z,t^&bx[|d+QST8aa֐ҸCmjDM$2"(S|67C0\Q-igd+ܽl1$r5>&ׅ+ݘn.zxZ>9:&9VB!}#Dm=FQf]dلů\!Bi=kxC ;#UY$]4I?^ޢw/U674:.F<y"[@~叝i@fj'oL7vI!9>2y<j5fswJձdȧzkL}Ն=bjA7]Jo=iơm{ec<&H\ۀOt5}	]DRȢkon6LM3ZB۠&ɪjمAD=eZHi.fHvTB,n[:z.4B2+:XiT:|5mjAY8u3Mpi8uE{ڋ~Q[i bLuZT,}Z;C}]!5E<MY/'3KW??y9_>̆&bhsGoIgR{ukt_V9^70fGV# XMv:~ZOک{a_hST",Gh$p.t~]V2	CFT^u;HU[eGڮ]rי3kx'I  $9ZԛOqI<dtο.d5=ٚoQ#--d5K~kFpM48)-n }&|~`'|n9G*jRqԙkn̶vgP4.(Qf~)8t7>mYpo;@DPc~^hҳ#)4K㣠W\y&!k$'+eT0>-kA@YJe	)T{ (=dmby]猲AuzpyvϣF[OXA&qsƬl`&a^W0;( )@'M$M*3yNY9TI\g*;_|5a,K>:!rxUSwNwSdGW`^e&Lu쪖I_]0Qצ2rCc-{Da *W*A$}폍46ufzcޡ)L{(.iL4p<d_eEyƂ	3S>A|"G7
Ad GQe/HN.W*+	z{ox9C	pz3H9S%@+gɱj1J^MB"S5)X/9xubΫ':R:B5F@&?
S1eJE`,}=p\rY[Z_ty$sI_ueeؔ<($S#b%<K'#5P,)syO|@hLYYk1nGϪTתXOшg3GKlؤǌ>hZ$`&SsXfʶM;
#rG??R_cC0ɌG*L&:(_j4ʊS2%հLii}irb>ҔڗcGM`lX=`jj,[ 1&>R<钷V* RRJ++38AWm|7_mnL-/+;3LɔM);PQ>%eʔjVV [.c.KƧzm'0**A0R5>0;T9OrIX=}cط՗#iŉd    IENDB` $$If     !v h5 X5%#v X#v%:V l 
t  0                                65 X5%/ p                yt2E t   D                                                                     T e x t 7                           t   D                                                                     T e x t 7                           t   D                                                                     T e x t 6                           t   D                                                                     T e x t 7                           t   D                                                                     T e x t 7                           t   D                                                                      T e x t 8                            $$If     !v h5 5#v #v:V l 
t  0                                65 5/ /      p                yt2E   D                                                               f                                2 C h i l d   C a r e   P r o v i d e r   R e g i s t r a t i o n   A p p l i c a t i o n   F A 3 5 0 ( C o n t r a c t   f o r   P u r c h a s e   o f   C h i l d   C a r e   C M - 5  C h i l d   C a r e   V e n d o r   I n v o i c e % A p p l i c a t i o n   f o r   V e n d o r   D i r e c t   D e p o s i t & O t h e r   f o r m   o r   d o c u m e n t   d e s c r i b e d   b e l o w    D                                                                    T e x t 1        M / d / y y y y                    $$If     !v h5 +#v +:V l .
t  0                                65 +/      p
        yt2E  $$If     !v h5 5#v :V l 	  
t              0                                65 p            yt2E t   D                                                               e     C h e c k 1                         t   D                                                               e     C h e c k 2                         t   D                                                               e     C h e c k 3                         t   D                                                               e     C h e c k 4                         t   D                                                               e     C h e c k 5                         t   D                                                               e     C h e c k 6                         t   D                                                                     T e x t 4                           t   D                                                               e     C h e c k 7                         t   D                                                               e     C h e c k 8                         t   D                                                                    T e x t 3                           t   D                                                               e     C h e c k 9                         v   D                                                               e     C h e c k 1 0                         v   D                                                               e     C h e c k 2 7                         v   D                                                               e     C h e c k 2 8                         v   D                                                               e     C h e c k 2 6                          $$If     !v h5 5#v :V l .
t  0                                65 /      p                yt2E  $$If     !v h5 5#v :V l 	  
t              0                                65 p            yt2E v   D                                                               e     C h e c k 1 5                         v   D                                                               e     C h e c k 1 6                         v   D                                                               e     C h e c k 1 1                         v   D                                                               e     C h e c k 2 9                         v   D                                                               e     C h e c k 1 2                         v   D                                                               e     C h e c k 1 3                          $$If     !v h5 5#v :V l 4
t  0                                6+5 /      p                yt2E  $$If     !v h5 5#v :V l 4	 
t  
      0                                6+5 p              yt2E v   D                                                               e     C h e c k 1 7                         v   D                                                               e     C h e c k 1 8                          $$If     !v h5 5#v :V l 4
t  0                                6+ +5 /     p                yt2E v   D                                                               e     C h e c k 2 5                          $$If     !v h5 5#v :V l 4 	   
t                0                                6+ 5 p              yt2E v   D                                                                     T e x t 1 1                            $$If     !v h5 5#v :V l 4
t  0                                6+ +5 /      p                yt2E  $$If     !v h5 5#v :V l 4	 
t  
      0                                6+5 p              yt2E v   D                                                               e     C h e c k 1 9                         v   D                                                               e     C h e c k 2 0                         v   D                                                               e     C h e c k 2 1                         v   D                                                               e     C h e c k 2 2                         v   D                                                               e     C h e c k 2 3                         v   D                                                               e     C h e c k 2 4                          $$If     !v h5 5#v :V l 4
t  0                                6+5 /      p                yt2E t   D                                                                     T e x t 9                            $$If     !v h5 5#v :V l 4 	 
t  
      0                                6+ 5 p              yt2E j   D                                                                                                 j   D                                                                                                 $$If     !v h5 5
5
#v #v
:V l 4 	 
t  
      0                                6+ 5 5
p                      yt2E                                                                                                                                                                                                                                       ^                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               2                     0  @  P  `  p                   2  (         0  @  P  `  p                      0  @  P  `  p                      0  @  P  `  p                      0  @  P  `  p                      0  @  P  `  p                      0  @  P  `  p      8  X        V  ~     _HmH	nH	sH	tH	    @  ` @       N o r m a l       CJ _HaJ mH	sH	tH	Z    Z   d   	 H e a d i n g   1     $ < @&  5CJ  KH  OJ QJ \^J aJ  \    \   d   	 H e a d i n g   2     $ < @&  56CJ OJ QJ \]^J aJ               D A  D         D e f a u l t   P a r a g r a p h   F o n t     R i@ R       0 T a b l e   N o r m a l      4 
l 4   a      ( k  (        0 N o   L i s t         j    j    l{   
 T a b l e   G r i d   7 :V 0                                   H   H   :    B a l l o o n   T e x t      CJ OJ QJ ^J aJ D  D   '8 0 R e v i s i o n      CJ _HaJ mH	sH	tH	PK     !         [Content_Types].xmlj0Eжr(΢Iw},-j4	wP-t#bΙ{UTU^hd}㨫)*1P'	^W0)T9<l#$yi};~@(Hu*Dנz/0ǰ$X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?   PK     ! ֧   6     _rels/.relsj0}Q%v/C/} (h"O
= C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/Seе   PK     ! ky         theme/theme/themeManager.xmlM
 @}w7c(Ebˮ CAǠҟ7՛KY,e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+&
8   PK     !   P     theme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$!)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu	gZo~ٺlAplxpT0+[}`jzA V2Fi@qv֬5\|ʜ̭NleXdsjcs7fW+Ն7`gȘJj|h(KD- dXiJ؇(x$(:;˹!I_TS1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ
x}rxwr:\TZaG*y8IjbRc|XŻǿI
u3KGnD1NIBs
RuK>V.EL+M2#'fi~Vvl{u8zH
*:(W☕~JTe\O*tHGHY }KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4=3ڗP
1Pm\\9Mؓ2aD];Yt\[x]}Wr|]g-
eW)6-rCSjid	DЇAΜIqbJ#x꺃6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8քAV^fHn-"d>znǊ	ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ ;%1U٥m;R>QDDcpU'&LE/pm%]8firS4d7y\`JnίIR3U~7+׸#mqBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D	vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCMm<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍ    PK     ! ѐ     '   theme/theme/_rels/themeManager.xml.relsM
0wooӺ&݈Э56?$Q,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{ P8g/]QAsم(#L[    PK-      !                       [Content_Types].xmlPK-      ! ֧   6               +  _rels/.relsPK-      ! ky                     theme/theme/themeManager.xmlPK-      !   P                 theme/theme/theme1.xmlPK-      ! ѐ     '             	  theme/theme/_rels/themeManager.xml.relsPK      ]  
    <?xml version="1.0" encoding="UTF-8" standalone="yes"?>
<a:clrMap xmlns:a="http://schemas.openxmlformats.org/drawingml/2006/main" bg1="lt1" tx1="dk1" bg2="lt2" tx2="dk2" accent1="accent1" accent2="accent2" accent3="accent3" accent4="accent4" accent5="accent5" accent6="accent6" hlink="hlink" folHlink="folHlink"/>    g    \         l	  	  
      A  :  ~  g  <  x=  >  ?  0R  R  R                                   !   %   &   (   +   -      	  
        g  P  <  <  =  X=  ~?  R  R  R                              "   #   $   '   *   ,   X   d   j   p   |                                            -  X  d  j      &  6  n  ~            	  -  9  ?  B  R          $  (  8  k  {        *  d  t  #  3  U  e          B  R  j  z          z
  
  
  
  
  
  
      N  ^                   
    (  .  5  A  G  g  FFFFFFtS FG G G G G G FG G FG G G G G G G G G G G G G G FG G G G G G FFtFt  L                         #    A    A    @                           0    (    	                    
          B    
        S              	   ?          %    T e x t 6  T e x t 7  T e x t 8 	 D r o p d o w n 1  T e x t 1  C h e c k 1  C h e c k 2  C h e c k 3  C h e c k 4  C h e c k 5  C h e c k 6  T e x t 4  C h e c k 7  C h e c k 8  T e x t 3  C h e c k 9  C h e c k 1 0  C h e c k 2 7  C h e c k 2 8  C h e c k 2 6  C h e c k 1 5  C h e c k 1 6  C h e c k 1 1  C h e c k 2 9  C h e c k 1 2  C h e c k 1 3  C h e c k 1 7  C h e c k 1 8  C h e c k 2 5  T e x t 1 1  C h e c k 1 9  C h e c k 2 0  C h e c k 2 1  C h e c k 2 2  C h e c k 2 3  C h e c k 2 4  T e x t 9 X           Y    '  o        -  C      )  l      e  $  V      C  k      {
  
  
    O          i                              	   
                                                                      !   "   #   $            .  k    7        
  @  S    %  9  |    +  u  4  f      S  {      
  
  
    _          i      i           S  X  (  -          9  T          Y  _  k
  o
      i   3  3  3  3  3  3  3  3  3  3  3      X   k   p                          .  X  k      &  7  n              
  -  @  B  S        %  (  9  k  |        +  d  u  #  4  U  f          B  S  j  {          z
  
  
  
  
  
      N  _                     /  5  H  f  i                                                                                      V                   % -B K Z| !> Es : Q I
 F E   9 TU% +}% Q& - P . ]. 31 F6 '8 : %<< #C E <E 2E 4F 4ZF NH xH ,LJ +MN vS HX #Y F4[ rK] tf` D-n Wo +p |p l{ Y pd c   | vn d L ?" VH $0 \<  { k4 y I  X[ = `; v m q K sC :n  D / Qn ) 75 vR u + <  R f     g  i         @d             :  :  
      g  `      `  
    `   @  `      `    @  `  <    `  | @  `  R        U n k n o w n                                   G  *                  T i m e s   N e w   R o m a n   5                       S y m b o l   3.  *                  A r i a l   5.  * a               T a h o m a   A     B               C a m b r i a   M a t h   "     h    妨s
چ       g             g         r!                                                                                                                                                                                                                                                                                                                           20              a  a                                                                        2                           HP    	 	?    l{    *                     !                             x   x                              D S S  S t e p h a n i e   L .   R o e t t g e n                                                                                                                                  Oh +'0                                                        	          
   <     H     T     `     l     t     |                                      DSS                           Normal.dotm       Stephanie L. Roettgen         2         Microsoft Office 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Department of Social Services                 a                                                         Title       P                 <      D            _NewReviewCycle                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        	   
                                                                      !   "   #   $   %   &   '   (   )   *   +   ,   -   .   0   1   2   3   4   5   6   7   8   9   :   ;   <   =   >   ?   @   A   B   C   D   E   F   G   H   I   J   K   L   M   N   O   Q   R   S   T   U   V   W   X   Y   Z   [   \   ]   ^   _   `   a   b   d   e   f   g   h   i   j   l   m   n   o   p   q   r   u   v   y   R o o t   E n t r y                                                 	           F            @Hlx          D a t a                                                         
                                     /   A      1 T a b l e                                                                                              P   %      W o r d D o c u m e n t                                          
                                              4\       S u m m a r y I n f o r m a t i o n                           (                                     c           D o c u m e n t S u m m a r y I n f o r m a t i o n           8                                        k          M s o D a t a S t o r e                                                                  I,lPDl            N 4  Y    W  U    G B I K  5    = =                 2                        I,lPDl            I t e m                                                         
 	                                                  P r o p e r t i e s                                                                                      U       C o m p O b j                                                                                            
   y                                                                                                                                                	      <b:Sources SelectedStyle="\APA.XSL" StyleName="APA" xmlns:b="http://schemas.openxmlformats.org/officeDocument/2006/bibliography" xmlns="http://schemas.openxmlformats.org/officeDocument/2006/bibliography"></b:Sources>                                        <?xml version="1.0" encoding="UTF-8" standalone="no"?>
<ds:datastoreItem ds:itemID="{CA58E935-D679-4FCD-AA90-60482A47E8BE}" xmlns:ds="http://schemas.openxmlformats.org/officeDocument/2006/customXml"><ds:schemaRefs><ds:schemaRef ds:uri="http://schemas.openxmlformats.org/officeDocument/2006/bibliography"/></ds:schemaRefs></ds:datastoreItem>                                            
  	           F'   Microsoft Office Word 97-2003 Document 
   MSWordDoc    Word.Document.8 9q                                                                                                                                                                                                                                                                                   