CD12-100, OEC12-17 October 3, 2012, CD12-14, OEC12-03 January 31, 2012

It is the right of any individual to apply for assistance, including individuals who are clearly ineligible.  Applications must be completed and signed.  Applicants have the right to appeal any decision made regarding their application within 90 days of the decision.  In order to guarantee these rights to all applicants, each person requesting assistance in the office will be asked to sign an application immediately.

All applicants must be made aware of the change reporting requirements for the Child Care Assistance program and that failure to report required changes or reporting false information may result in prosecution for fraud.


CD12-100, OEC12-17 October 3, 2012, CD12-14, OEC12-03 January 31, 2012
  1. Request In Person: Obtain a signed application form and complete the interactive interview.  Retain the signed application and signed interview summary in the case record.  Provide the IM-4 CC and IM-4 hearing rights brochures to the applicant.  A copy of the signed application and/or interview summary may be provided to the applicant, if requested.
  2. Request By Mail or Fax:  If a request for application is received by mail or fax, enter the application in FAMIS and attempt to contact the applicant by phone no later than the next business day.  If phone contact is not successful, send an FA331 Appointment Letter no later than the next business day requesting an interview within five (5) business days.  Once the interview is conducted, write "phone interview" on the client signature line and enter the date of the phone interview on the interview summary.  Send a copy of the interview summary, along with the IM-4 CC and IM-4 hearing rights brochure to the applicant.
  3. Request by Telephone:  record the name and address of the person requesting assistance, as well as the date of the request.  Mail a paper application form no later than the next business day, along with an IM-4 CC, and IM-4 HEARING RIGHTS brochure.

NOTE:  The application has not been filed until the signed application form is received by the agency.

NOTE:  The IM-3 Changes You Must Report form is no longer required as of September 17, 2012.


CD12-14, OEC12-03 January 31, 2012

The claimant, legal guardian, conservator, authorized representative, or power of attorney may sign the application.  If the applicant has a conservator, instruct the court appointed conservator to sign and complete the application. If the claimant has a guardian, either the guardian or the claimant may sign the application. If needed, conduct the interview with the guardian or conservator.  The claimant's presence is not required. A claimant who applies on their own may designate an Authorized Representative at any time to assist them in completing the application process.

NOTE:  If the signature is by mark, two witnesses are necessary.


CD12-14, OEC12-03 January 31, 2012
  1. Where to File

    Applications should be filed and registered timely in the applicant's county of residence.

  2. Requests from Individuals Not Living in the County

    If the individual makes a request in person, take the application, register it no later than the next working day, and transfer it to the correct county.

    If an application is received in the mail, date stamp the form, register the application no later than the next working day.  Transfer the pending application to the correct county.

    If the request is received by phone, mail the application within one working day of the request.  Include a return envelope to the correct county.

  3. Applicant Moves to Another County

    When an applicant moves to another county before the application has been processed, transfer the case to the receiving county.  Before transferring, record all activity on the case up to the time of transfer.


CD12-100, OEC12-17 October 3, 2012, CD12-14, OEC12-03 January 31, 2012

During the interview, have the applicant complete and sign the application. However, if the applicant does not want to sign an application or says that only information is wanted, give the requested information. Such a request is considered a request for information if no application form is signed.

  1. Explain the child care eligibility requirements to each applicant. Discuss fully any point on which the applicant has indicated particular concern. Make sure that each point of eligibility is covered as the interview progresses.
  2. Explain that child care applications must be resolved within 15 calendar days.
  3. Explain the department’s non discrimination policy.
  4. Explain the department’s hearing policy.
  5. Offer voter registration to each household member of voting age.  Follow voter registration policies as outlined in 0105.026.00 VOTER REGISTRATION REQUIREMENTS in the Income Maintenance manual.
  6. Explain the process of accessing child care services, if eligible.  Refer applicants needing assistance in choosing a child care provider to Child Care Aware®.
  7. Notify the applicant in writing of the information needed to determine eligibility in a clear, understandable manner. Inform the applicant of his or her responsibilities as well as deadlines for supplying needed information.
  8. Date stamp any documentation or correspondence provided with the date received. This includes information obtained during the initial interview.
  9. An applicant shall not be required to provide documentation if the division has access to the information, unless it is inaccurate, incomplete, or insufficient. During the initial interview, have the applicant complete and/or sign the needed forms to obtain needed information or establish eligibility.
  10. An application should not be rejected because of failure of a person outside the household to provide information. Explore all methods of establishing eligibility on those factors in question.
  11. Provide and explain to each applicant the IM4 CC and IM4 Hearing Rights forms. If at any point during the interview it is apparent that the applicant is ineligible, if possible, give the individual a full explanation of the reasons for ineligibility. In addition, explain to the applicant that she or he is not responsible for verification of information causing ineligibility. Inform the individual that if the application is rejected, a new application may be filed at any time.


CD12-14, OEC12-03 January 31, 2012

Each applicant has the right to withdraw their application at any time. If the applicant chooses to withdraw, obtain a written statement of withdrawal.

When an application is voluntarily withdrawn, show the reason for the action and clearly indicate that withdrawal was made at the initiative of the applicant and without pressure from the Eligibility Specialist.


CD12-14, OEC12-03 January 31, 2012

If an applicant has previously applied for or received assistance from FSD, there should be a record of past contact. In an interview of this type, review the existing record and the points of ineligibility if known, for previous closings or rejections. No further exploration is necessary regarding points of eligibility that are not subject to change and which have been satisfactorily established in the earlier record.

If it is indicated that an individual has previously applied for or received services through another county office, explore the applicant's understanding of the closing or rejection reason, and what changes have occurred since that time.


CD12-14, OEC12-03 January 31, 2012

Case processing begins with receipt of the application at the local FSD office.  Once household eligibility has been established, the household can access child care benefits from either a licensed and contracted child care provider, or a provider that is registered with DSS for payment of child care services.  In order to access benefits, the Eligibility Specialist must authorize the child/ren to the chosen provider.  Refer to 1220.025.00 INDIVIDUAL AUTHORIZATION PROCESS.  Households may not access benefits until the chosen provider is licensed and contracted or registered with DSS for payment of child care services and the Eligibility Specialist has authorized the child to the provider.


CD15-19, OEC15-07 April 20, 2015, CD12-14, OEC12-03 January 31, 2012

Reject the child care application on or before the fifteenth (15) day from the date of application if:

  1. The applicant fails to participate in an interview, but only after the eligibility specialist attempts to contact the applicant by phone and by mail to request an interview;
  2. The applicant voluntarily withdraws the application;
  3. The applicant fails to provide necessary verification as requested on the Request for Information form within ten (10) calendar days.  If the tenth day falls on a weekend or holiday, then the due date is the next business day;
  4. The applicant is found ineligible for child care services;
  5. The applicant has a child care overpayment and has not agreed to a repayment plan (See Section 1220.000.00);
  6. The applicant has a valid repayment agreement or promissory note and has not complied with the terms of the agreement (See Section 1220.000.00); or
  7. The applicant has an outstanding sliding fee payment owed to a past provider and has not entered into a repayment agreement with that provider (See Section 1225.040.10).