To submit this form, you can email it to Child.FamilyWellBeing@acs.nyc.gov or fax it to the provided number. Alternatively, submit it in person or through an online submission form available on the official website. Ensure all required fields are completed and all necessary documents are attached.

The purpose of this form is to assist families in applying for child care assistance in New York City. By providing accurate information and required documentation, parents and guardians can receive necessary child care support. This form streamlines the application process and ensures eligibility requirements are met.

• 1. Applicant Information: Includes details like name, address, and contact information.
• 2. Children Needing Care: Lists all children requiring child care assistance, including their personal details.
• 3. Household Members: Details of other household members not needing child care, including their relationship and age.
• 4. Employment Information: Employment details of the applicant and any second parent/caretaker, if applicable.

Failure to submit this form may result in ineligibility for child care assistance. Ensure all required information is provided and the form is submitted on time.

• Ineligibility: Not submitting the form means you won't qualify for child care assistance.
• Delays: Late submission can cause delays in processing your application.
• Incomplete Application: Incomplete forms will not be considered, resulting in the need for resubmission.

• 1. Initial Application: First-time applicants for child care assistance must use this form.
• 2. Recertification: Current recipients of child care assistance must recertify by filling out this form.
• 3. Change of Circumstances: Use this form to report any changes in your household or employment status.
• 4. Additional Children: Add more children needing care by submitting an updated form.
• 5. Request for Documentation: Use this form if you are asked to provide additional information or documentation by the authorities.