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Larimer County Human Services

Food / Medical / Financial Assistance

Child Care Assistance Program (CCAP)

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Forms for all CCAP Providers

W-9 [pdf]
LCHS 4204 Fiscal Agreement Instructions [pdf]
LCHS 4208 Sign In/Out [pdf]
LCHS 4211 Attendance Record & Billing [pdf]
LCHS 4272 Acceptable Billing Formats [pdf]
LCHS 4273 Payment Schedule [pdf]
LCHS 4220 Payment Options [pdf]
LCHS 4223 Agreement to Pay Overdue Parental Fees [pdf]
LCHS 4224 Unpaid Parental Fee Report [pdf]
Direct Deposit [pdf] 152 KB

Note:

will delay payment

Please mail to:

Forms for Licensed Centers		Forms for Licensed Homes
Licensed Center Provider Handbook LCHS 4267 Fiscal Agreement, Licensed Center [pdf] LCHS 4207 Contract Addendum, Licensed Center [pdf]		Licensed Home Provider Handbook [pdf] LCHS 4237 Fiscal Agreement, Licensed Home [pdf] LCHS 4206 Contract Addendum, Licensed Home [pdf]

Forms for Exempt (not licensed) CCAP Providers

Exempt (not licensed) Provider Handbook [pdf]
LCHS 4297 Fiscal Agreement, Exempt [pdf]
LCHS 4263 Non-Licensed (exempt) Self-Assurance form [pdf]
LCHS 4286 Exempt Family Child Care Home [pdf]
LCHS 4287 Authorization to Supply Information [pdf]
LCHS 4289 Exempt Initial Billing [pdf]
LCHS 4233 Contract Addendum, Exempt Provider (rates) [pdf]