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Child Care provider Application form

The Department of Family and Protective Services inspects and monitors child care providers. You can view child care providers for their compliance with state standards at: dfps.state.tx.us DFPS Office in Harlingen DFPS Office in Edinburg (956) 423-0130 (956) 316-8275 ----- Choosing a Quality Child Care Provider Form 2910, Application for a License to Operate a Child Day Care Facility Form 2948, Plan of Operation for Licensed Center Operations Form 2911, Child Care Licensing Governing Body/Director Designatio

Child Care Center (CCC) Documents and Forms . Translated documents and forms were made possible by Grant Number 90TP0046-01-00 from the Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services January 2021 ☐ 12. Have on file a Child Care Enrollment Information form (CD-257) for each child in your care.This form should be updated annually or as changes occur. ☐ 13. Have on file a Medication Authorization form (BCC-11) for all children requiring medication during care.This form should be updated as changes occur Download a CCDF Provider Eligibility application. Application packets. If you have reviewed the requirements for becoming an authorized CCDF child care provider, and are ready to apply, please select the appropriate application below, print and follow the instructions to complete and submit your application

Child Care Application Form The Child Care Application is used when initially applying for child care or when a previous child care case is no longer active. Download and print a paper application here. Usted puede descargar e imprimir una solicitud en papel aquí Provider Forms CC10 - Approved Child Care Provider Disaster Preparedness and Emergency Evacuation Plan CC11 - Approved Relative Child Care Provider Health and Safety Requirements CC12 - Child Care Provider Rates And Responsibilitie

Childcare Management Software - Get Started Toda

Forms for adult foster care providers serving individuals on Elderly Waiver Forms for child care centers are now located on the updated Licensed Child Care Centers web page. Forms for child foster care • Minnesota Adoption and Child Foster Care Application DHS-4258A (9-17) (PDF This contains instructions needed to file an application for a Family Child Care Home license, and to gain access to and print forms. Family Child Care is non-medical care and supervision for children, in the provider's own home, for periods less than 24 hours. A license may be issued for a Small Family Child Care Home or a Large Family Child. Supervision Report Form ICPC Parent-Guardian Placement Evaluation. ICPC - Tips - Reminders during COVID August 2020. EZ Way to Prepare an Approvable ICPC Packet August 2020. Residential Child Care and Child Placing Licensing Forms Residential Child Care and Child Placing Waiver Residential Child Care and Child Placing Agency License Application Contracts (provider agreements) and registration agreements must be in place before a child can be authorized to a provider to receive payment of child care services. Based on which category a provider falls into, the application process will vary child care provider with Care 4 Kids (C4K), you must provide us with your Social Security Number or Federal Employer Identification Number and fill out an IRS W-9 form. To get a W-9 form by mail, call 1-888-214-5437, or download the form

Child Care Home Provider Application Forms Texas Health

Application for License to Operate a Child Care Facility; Center Director/Group Day Care Home Provider Approval Request; Center Director/Group Day Care Home Provider Certification Request; Child Care Practices and Concepts; Child Care Enrollment Form; Child Care Work Experience; Child Enrollment For License-Exempt Facilitie It is important that you complete the DHS Child Care Provider Listing form and send it in to the DHS Direct Pay Unit (DPU) right away. The listing form must be received and processed before a billing form can be sent to you. You will need to receive a billing form so you can be paid To order hard copies of available OCFS forms and publications, submit form OCFS-4627:Request for Forms and Publications to: Child Care: All Providers. How to Complete the Application for Child Care Assistance. Yiddish When you have obtained at least 24 months of Canadian experience, within 36 months of your occupation-restricted work permit being issued, as a home child care provider or home support worker, you may return to this guide to submit your proof of qualifying work experience as part of your application for permanent residence under these pilots 5/18/2010-OOL Page 1 of 5 Provider Application Form for Family Child Care Registration Please print all information. Attach additional sheets if more space is needed

Child Care Center (CCC) Documents and Forms - NC DHH

  1. DCYF #15-894 Family Home Child Care Liability Insurance Form; Fire Safety Fire Safety & Emergency Drills Form. WAC 110-300-0470(4) requires family home providers and child care center providers to use this DCYF form. School-age providers may use this form, but WAC 110-305 does not require use of this specific form
  2. To apply for a Child Care Home or Center license see the instructions below and apply online at MiLogin. Only updated Internet Explorer, FireFox, or Google Chrome browsers are compatible with MiLogin. You may be required to add Michigan.gov to your compatibility view settings for the application.
  3. Education (MSDE) pays for center care, family child care, and informal care. CCS Central staff can explain the different types of care, voucher, subsidy and copayments, if you call 1-866-243-8796. On the application, please make note of the Date of Birth and Contact Phone Number you enter in Section 2
  4. Apply Here SNAP & TANF Forms SNAP/TANF Prescreening Application SNAP/TANF Online Application SNAP E&T Skills2Work Application Child Support Forms Apply fo
  5. Care at a provider not on this application? If yes, list all child care provider names and registration YesNoYes You must complete a separate child care arrangement Section 4 (page 8) for each provider. numbers (if assigned) you seek assistance in paying: List all other child care provider(s) such as Head Start, Pre-K or Child Care at a.

Download a CCDF Provider Eligibility application - Carefinde

Child Care Assistance Program Forms - Illinois Actions for

  1. CF-FSP Form 5211, May 2019, Florida Child Care Staff Credential Verification Application, 65C-22.001(7)(d), F.A.C. Page 1 of 5 RESOURCE PAGE A staff credential is used by child care providers to validate credentials and experience for licensing compliance and participation in the Voluntary Pre-Kindergarten (VPK) Program
  2. Child Care Provider Information. Application For Approval: Relative Child Care Provider Form; W-9 form (Complete and submit to the human service zone office (formerly called county social service office) or Department with your Application for Approval: Relative Child Care Provider form) Child Abuse and Neglect Background Inquiry form (SFN 433
  3. istrator of the Child Care Subsidy Program to verify licensure and/or regulation status. Once you are notified by a VA employee that they submitted an application for child care subsidy from the Department of Veterans Affairs, please complete this form an
  4. Commonly Requested Child Care Licensing Forms The Benefits of Developmental Monitoring and Screening for Young Children: English , Spanish , Somali , Arabic ; Kidcentraltn(Development) Child Care Observation Documentation: Use of Developmental Learning Standards form
  5. DCD-0450i: Copy of Child Care Action Notice and Instructions: Sep 01, 2007 02:10 PM DCD-0450-2i: Copy of Child Care Action Notice Continuation Page: Sep 01, 2007 02:10 PM DCD-0451i: Copy of Application for Enrollment to Be a Provider of Subsidized Child Care and Instruction

Child Care Forms - Alaska Department of Health and Social

The Child Care Services Program provides child care subsidies to an average of 9,000 children per day through more than 600 local child care providers. Child care services are available for both full and part-time care for qualifying families. Qualified families may encounter a wait period for service availability Child Care Provider Forms 5 Children Children and Family Services What you need to know. General: Child Care Center Reimbursement Request. Child Care Provider Agreement. Child Care Provider Health and Safety Training Verification. Child Care Verification Form. Relative License Exempt Form If you are a child care provider, please contact billing staff by email for assistance or with any questions you may have. Eligibility for the Child Care Assistance Program. Applicants must meet eligibility requirements in 922 KAR 2:160.An applicant can see if they are elgible by using the Prescreening Tool.. To apply please call toll free (855) 306-8959 or visit kynect

MDHHS - Forms & Application

Child Care Certification Forms and Publications. There are a number of useful application forms and other documents for certified child care providers. Use the two searchable tables below to locate Certified Family Child Care Application Forms and Certified Operator Forms Division of Regulated Child Care. Forms for Child Care Facilities. Forms include applications, renewals, licensing information and other information. Certified Appeal Request Form: DRCC: Certified Provider Renewal Packet: DRCC: Certified Renewal Application en Espanol: DRCC: Type I or Type II Licensed Child-Care Initial Application.

We recommend providers submit the Child Care Provider Reopening Application at least 48 hours in advance of their reopening date. Child care facilities that do not receive approval from DCDEE to reopen will not be allowed to reopen or be approved to provide child care until further notice Parents pay a portion of the child care, called a copay or copayment, directly to the child care provider. We use the following information to determine how much the state will pay to the child care provider: Number of hours parents are working, in school, or participating in approved activities; Household incom Child care providers can receive a reimbursement rate once they provide child care services which are appropriate for the child and demonstrate increased costs as a result of the child care. Special Needs Applications are only available for those children with an active child care subsidy voucher case Forms The Division of Family Development (DFD) contracts with the CCR&Rs, located in each county to administer the Child Care Subsidy Program. To learn more about state subsidies, or for help in finding quality child care, call the Child Care Helpline at 1-800-332-9227 or contact your county's CCR&R. Parent Brochur Almost all child care programs in the District of Columbia must be licensed. (There are some exemptions. Here is a list of programs that do not need a license.) Licensing Process. To become licensed for the first time, a child care provider must go through the following process: 1. The provider completes the child development center or home.

Forms. To look at and print the forms, you may need to install Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader, click here to download it for FREE. General Forms. Care 4 Kids Application Form (English) Solicitud de Care 4 Kids (Español) ; Parent Provider Agreement Form (PPA) (English) Formulario del Acuerdo Entre Padre y Proveedor (PPA) (Español A program or provider that is licensed by DOHMH to provide child care must become affiliated with ACS in order to accept vouchers to provide child care. The first step is to call the ACS Early Care and Education call center in order to be sent an application packet at (212) 835-7610 Licensed child care centers, family child care homes, and in-home child care providers are all eligible to become CCPP-approved providers. Parents may choose any type of child care while participating in this program as long as the provider has completed the application and approval process

• All child care providers/staff will have a physical examination no more than two years old and a TB skin test documented and on file in the facility/home within 90 days of the signature date on this form Form OEL-VPK 20 (Provider Agreement) Form OEL-VPK 20A (Provider Agreement Amendment) Form OEL-VPK 20PP (for Private Providers) Form OEL-VPK 20PS (for Public Schools) Form OEL-VPK 20B Logotype Usage & Brand Guidelines; For more information on completing VPK Forms/Contracts, please see the Office of Early Learning's webpage COVID-19 application for registration to operate as a Family Child Care Provider or an In-Home Provider With the recent events surrounding the onset of COVID-19, applications to register or renew registration as a Family Child Care Provider and In-Home Provider are not required to be submitted in CAFÉ Child Care Provider Orientation Forms . Please contact your local Resource and Referral Office to complete a phone orientation. Resource and Referral offices can be located by following this link. Forms for provider orientation: Payment forms: Direct Deposit Application. To qualify for the Illinois Department of Human Services Child Care Assistance program: Use the Eligibility Calculator to see if you are eligible for child care assistance. Find a child care provider who will be willing to accept the child care assistance funding. If you would like a list of providers in your area please call us at (630)790-6600

Child Care Assistance Program (CCAP) Louisiana

Any provider who earns $600.00 or more in the calendar year will be issued a 1099 Form for income tax purposes. Child care providers are not employees of the State of Illinois, nor of Child Care Resource & Referral. We do not provide employment verification All applications for permanent residence under the Home Child-Care Provider and Home Support Worker pilots must be submitted to the Case Processing Centre in Edmonton (CPC-E), in Alberta. A maximum of 2,750 complete applications will be processed per year in each pilot, as authorized by Ministerial Instructions All child care providers may reopen by contacting their licensing specialist and complete a Child Care Verification of Reopening form. Please note, that child care programs applying for grants from the Division of Early Childhood (e.g., accreditation, quality improvement, etc.) must have completed a Child Care Verification of Reopening form and.

Division of Child Care & Early Childhood Education The Division of Child Care and Early Childhood Education knows that the earliest years are critical for brain development and learning so they work to ensure children and families have access to a safe, high-quality, and nurturing care Child Care Resource and Referral Contact Request (Form 2525) Child Care Provider Enrollment (Form 1862) (effective August 3, 2020) Criminal History Record Information Authorization (DSSP372) Child Care Scholarship Background Check Requirements Fact Sheet for License-Exempt Child Care Program Employee or Volunteer (Form 2522 ERDC also works with providers and other child care partners across the state to help families find and keep good child care, improve the availability of quality child care in Oregon, and to develop resources for parents and child care providers. Update starting 04/01/19: The ERDC program can now assist families with the cost of registration. Return completed application form and a copy of your current Community Care and Assisted Living Act Licence for each facility to: Please contact the Child Care Service Centre if you have any questions Bright from the Start Georgia's Department of Early Care and Learning. Meeting the child care and early education needs of Georgia's children and their families

Family, Friend & Neighbor Child Care (FFN) Includes Relative Care Exempt (RCE) providers . New Application Checklist . The provider must complete, sign, and submit the following: • FFN New Application form • Family Association form • Certification Checklist form • Health and Safety Checklist form • Medication Administration. Programs for Parents is designated as the Child Care Resource and Referral Agency for Essex County by the NJ Department of Human Services, Division of Family Development. The major funder of Programs for Parents is the State of New Jersey

Child Care Licensing Forms - Texas Health and Human

  1. General provider information. Child care provider information, to seek a provider, call 1-(800)-446-1114. Payment start dates will depend on the type of provider chosen, (licensed or unlicensed) and the provider's eligibility, including including verification the provider passed the background check
  2. Applying for a Child Care Center License In Minnesota, a child care provider is required by state law to obtain a license to operate a child care center unless the provider meets an exemption in state law.Licensure provides the necessary oversight to ensure child care is provided in a healthy and safe environment, by qualified people, and meets the developmental needs of all children in care
  3. $600,000 is targeted to registered family child care homes; Child Care providers in Prince George's County may apply for grants to cover expenses through the Child Care Provider Recovery Program. Eligible child care providers may receive a grant up to $20,000 for licensed child care centers and up to $3,000 for registered family child care homes
  4. Select Forms below. Most forms for the Child Care Assistance Program are no longer accessible on-line. Parents and providers can call or request on-line to have a forms generated through the system. If you have questions, please call the office. Application (click here) - this is the current CCAP application
  5. The following bullet points are here to help you through the Child Care Provider Application and Approval Process. W-9 Form (Form is available for download at www.americorpschildcare.com); Upon approval of your child care application, no payments will be issued without a completed W-9 Form
  6. T RUSTLINE AND HEALTH AND SAFETY ELF-CERTIFICATION/FACILITY CHECKLIST (Continued) Æ The Trustline application TLR 1 and TLR 508 forms should be requested as soon as you request child care or within 7 calendar days from the date child care services begin. Æ Your child care provider may contact the local Resource and Referral (R&R) office (see listing on page 2) to get
  7. Resource Development \ Family Child Care Forms 1. 2015 Family Child Care (FCC) Eight-Hour Preservice Training Registration Form More information Mandatory two-day training for those applying to become registered family child care (FCC) providers. 2. Five-Page Application for Family Child Care
Outstanding Checks Application Letter Form printable pdf

Air Force Family Child Care License Application Continuation Statement of Conviction FMP FCC 9 - OCT 2006 In accordance with Air Force Instruction 34-276, Family Child Care Program, paragraph, A5.36.4, There is no evidence of illegal drug use, child abuse, or domestic violence current or past in the household. The provider Portal Home Parents Providers Child Care Search Education & Training Repayment Log In. Menu. Home. Parents. Providers. Child Care Search. Education & Training. Repayment. Log In. Child Care Assistance Application Form. Pre program for a minimum of 25 total combined hours a week or more)? OR Are you a teenage parent - 18 & younger, who needs. The contents of this web page are intended to assist existing and potential child care providers in applying for a license to operate a child care, and to comply with the Rules governing child care programs. Below you will find the application materials that you must submit to the Department, and the Rules for the type of child care program you wish to operate

IDHS: Child Care Applications-Apply Onlin

Child Care Provider Verification (Form 1863)(effective August 3, 2020) Child Care Provider Web Billing Account Request (Form 2679) Child Care Provider Web Billing Training Manual (Form 2531) Child Care Resource and Referral Contact Request (Form 2525 Form OEL-VPK 05 Reenrollment Application (May 2016) Form OEL-VPK 07 Voluntary Prekindergarten Handbook. Form OEL-VPK 10 Statewide Provider Application 06-13-13. Form OEL-VPK11A, Class Registration Application - Instructors 06-13-13. Form OEL-VPK11B, Class Registration Application - Calendars 06-13-13. Form OEL-VPK 25 Training Requirement Application to Determine CCS Program Eligibility (DHCS 4480) Alt: Spanish CCS Special Care Center Directory Update Form (DHCS 4507) Child Health and Disability Prevention (CHDP) Program. CHDP Health Assessment Provider Application (DHCS 4490) CHDP Health Assessment Provider Program Agreement (DHCS 4491) CHDP Laboratory Provider Application.

Child Care Provider Scholarship Program. Schlarship Information Sheet-12-2015 (PDF) Child Day Centers (CDC) Application Forms by Category Children Under Age 19. Apply Online Through CommonHelp; Other Ways to Apply for Medical Assistance (PDF) Parents & Caretakers of Dependent Children FL Dept of Health in Pinellas - Pinellas County Child Care Licensing Program 727-507-4857 PinellasPCLB@flhealth.gov Fax. 727-507-4858 Mailing Address. Mid-County Offices 8751 Ulmerton Road, Suite 200

Form 2935 Download Fillable PDF or Fill Online Admission

APPLICATION FOR CHILD CARE BENEFITS . If you are working, in training or in school, you may be able to have part of your child care costs paid by the Ohio Department of Job and Family Services (ODJFS). Your eligibility will be based on your monthly gross income and your family size. You will have to pay part of the cost of the child care You plan to claim a credit for child and dependent care expenses on Form 1040 or 1040-SR, or . 2. You receive benefits under your employer's dependent care plan. If either 1 or 2 above applies, you must show the correct name, address, and taxpayer identification number (TIN) of each care provider on Form 2441, Child and Dependent Care Expenses Applications to become a Family Child Care provider in the State of Ohio are submitted to the Ohio Department of Job and Family Services. Complete applications are forwarded to the county of residence for processing and licensing recommendation IL444-3455 (R-8-16) Child Care Application Printed by the Authority of the State of Illinois Page 3 of 17 Parent/Guardian Name: If yes, list all child care provider names and registration numbers (if assigned) you seek assistance in paying: List all other child care provider(s) such as Head Start, Pre-K or Child Care at a provider not on this. VA Form 0730b: Child Care Provider Information VA Form 0730h: VA Child Care Subsidy Program Benefit Payment Request Form; SF-3881: ACH Vendor/Miscellaneous Payment Enrollment Form ** Note: All applications for the Child Care Subsidy Program should be created using the on-line automated process the Child Care Records Management (CCRMS) - See.

Child Care Forms - Department of Human Service

Child Care Licensing. The role of the Child Care Licensing Program is to regulate and monitor child care facilities. Additionally, the Program establishes guidelines for the health, safety and well-being of the children in these facilities During the interview, parents are asked to choose a child care provider and are issued a Child Care Certificate and Provider Confirmation Form to be completed by the chosen provider. The parents are given a Choosing The Right Caregiver for your Keiki brochure and Health and Safety Checklist, to provide guidance in making their choice Open PDF file, 140.18 KB, for Family Child Care Sample Forms Packet - Spanish (Paquete de Formularious de Muestra Para el Cuidado Infantil Familiar) (PDF 140.18 KB) Open PDF file, 49.99 KB, for Notice to Parents Regarding Supervision of Children Involving Transportation (PDF 49.99 KB To access the child care provider application form in the PEP individuals must first have registered for a PRODA (Provider Digital Access) account. The PRODA registration process will require individuals to provide documentary evidence of their identity The provider must be an active participant in the Child Care Assistance Program. Families may contact the Program Eligibility Specialist to request a list of child care providers that participate in the Child Care Assistance Program or call 1-800-322-8176. Families may also use the Search for Child Care

Child Care Licensing - California Department of Social

  1. Applicants are required to participate in an approved activity like work (full or part time), school or a qualifying training program. Applying for child care services through Hamilton County Job and Family Services requires you to complete both an application and to submit verification documents
  2. Child care centers and group child care homes enter: FEIN: Family child care homes enter: SSN: or FEIN: Tax type, tax number, and IRS documentation must be provided in order to participate in subsidized child care program or resource and referral, or both. 4
  3. e if your family is eligible for financial assistance. The DOE usually makes a decision within 15 days after receiving the application from the child care program

Child Abuse and Neglect Training/AIDS and HIV Infection Training. Child Care Attestation of Good Moral Character. Child Care Vehicle Inspection. Child Enrollment Information - #1. Personnel Record - #6. Physical Examination Form for Driver Applicant. Physician's Statement of Good Health for Child Care Center Personnel - # Apply to receive Child Care Payments as a non-registered child care home R enew or Make a Change to your child development home registration Renew or Make a Change to your CCA Provider Agreemen Documents & Forms. DFS201rev - Bill for Child Care Services; DFS203a - Registration Form for Licensed Providers; DFS203b - Registration Form for Unlicensed Providers; SS-26 - Application For Child Care Abuse/Neglect and Adult Central Registry Screens (PDF Version

The form is not a DFPS-specific form, and is intended for use by any family that wants to ensure a child's needs are being met in the parents' absence. DFPS cannot provide legal advice to members of the public regarding the use of this form Child Care Services includes Child and Adult Care Licensing, Child Care Payment Assistance (Smart Steps and the Child Care Certificate Program), Child Care Assessment and other partner programs. DHS is committed to promoting early childhood environments that are safe, healthy, and educationally rich Family child care providers achieve this high level of quality through a process that examines all aspects of the family child care program, i.e. relationships, the environment, developmental learning activities, safety, health, and professional and business practices HC CCL 62 - Licensing Procedures for New Child Care Facilities - Español HC CCL 92 - School Age Child Care Licensing Application Form - English HC CCL 99 - School Readiness Provider Application - English Know Your Child Care Facility Brochure - English Family Child Care Homes Forms

Licensing Forms - dhs

10.9.2.6 Child Care Registration Form Rev. 04/12 Who does not have permission to pick up your child? If applicable (A copy of supporting court document must be on file) Name Reason Child's health information Date of child's last physical exam: Child's health care provider Telephone number ( ) - Street address City Zip cod Page 2 - Parent Information for Choosing a Child Care Provider; Pages 3, 4, 5 - CCS Eligibility Packet Checklist (includes the list of required documents and fax information for submitting your complete application). If you have any questions, please contact Abigail Reyes (956-969-6154) or Rebecca Rios (956-969-6112). CCS Application Forms

Provider Forms - West Virginia Department of Health and

Reports, Forms, Pamphlets and Policies. You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.. Find a Document. Click on the tab that corresponds with the type of document type you are looking for, or click on the All Documents tab to search through all available documents General Information for All DCF Child Care Providers ALL DCF Child Care Providers must be U.S. citizens or legal permanent residents with a valid Social Security number. DCF completes extensive background checks on the provider, household members, age 10 or older, and volunteers (if applicable). These backgroun MSDH Approved Child Care Courses; Resource Guide for Child Care Providers; Training Organizations with Standing Approval; Become an MSDH Approved Trainer. If you wish to become an approved professional development trainer, download and complete application below. Professional Development Trainer Initial Application Change of Provider Form: is used to change to a different provider or add an additional provider to your case. This form is also used when you are adding a child currently included in your family size to to an existing child care provider. Forms. Child Care Application **new form Child Care Application - Spanish **new form Income Verification. The Ohio Department of Job and Family Services (ODJFS) helps parent(s) who are working or in school pay for child care through the Publicly Funded Child Care (PFCC) program. You may be required to pay for part of your child care in the form of a copayment. The amount you pay is based on your gross income and family size

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Child Care Licensing Forms & Publications. There are many forms and publications to help child care providers run a child care business in Wisconsin. From policy samples to incident reports, enrollment forms, background checklists, and more, you'll find a variety of resources to help you. Muaj ntau hom ntaub ntawv ua lus Hmoob Florida's Child Care Resource and Referral Network or CCR&R helps families locate quality child care and early education programs. Trained specialists offer information about local child care options and develop customized lists of child care providers based on each family's specific child care needs Paying for child care can be difficult for families with low incomes. Minnesota's Child Care Assistance Program (CCAP) can help families who qualify. Child Care Assistance along with the MN Department of Education's Early Learning Scholarship can help pay your child care expenses to eligible providers. To find licensed providers in your area, contact Parent Aware at 888-291-9811 In-Home Care Provider: parent or guardian selects the provider to care for the child in the child's home. Eligibility determination and intake must be performed by the DHS. Note: Relative Care Providers and In-Home Care Providers are exempt from the licensing requirements and are referred to as care-of-last-resort according to the Day.

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