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Report a Change

  1. Please Note:

    Child Care Services (CCS) will contact you within five (5) business days of receipt of the request.

  2. New Relationship Status:

    If selecting "Married," provide a copy of the marriage certificate, the spouse's Social Security Number, and the spouse's date of birth. If applicable, add spouse to Food Stamps case.

  3. Relationship:

  4. Additional Dependent:

    Provide a Child Support Verification Form, copy of birth certificate, and social security number to enroll.

  5. New Dependent:

  6. Change of Income

    Provide 2-4 check stubs or a Wage Verification Form.

  7. Type of Change:

  8. Change in Employment/Training

    Provide a copy of your work schedule.

  9. Change:

  10. Change in Total Hours

    Provide a copy of work schedule.

  11. Days of the Week:

  12. Temporary Incapacitation

    Temporarily unable to work due to illness, injury, or maternity leave. Documentation will be required.

  13. Temporary Suspension of Child Care

    Documentation may be required.

  14. Leave This Blank:

  15. This field is not part of the form submission.