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Child Care Voucher Program: Application Process
In January of each year, Child
Care Voucher applications and instructions become available when
W-2 forms are ready.
Completing Your Application
To prove your dependent care expenses, your child care provider(s)
for the previous calendar year must sign your application form to
verify that you paid them for child care. The completed application
also must be signed by you and your agency payroll officer. Please
follow the steps below:
1. Obtain an Enrollment Application
Form (Form ADM 4306) and complete the
employee portion.
2. Give the form to your child care provider(s) so they can complete
their portion, or attach a receipt which includes the following
information:
- Provider name;
- Provider address;
- Provider phone number;
- Dates care was provided;
- Tax ID number (if available) or Social Security number; and
- Provider signature.
3. Attach a copy of your federal IRS income tax form IRS 1040,
which shows your family adjusted gross
income.
- If you were married as of December 31, your spouse's adjusted
gross income must be included, even if you did not marry
until the end of the year, or you were separated for part
of the year.
- If you and your spouse file jointly, you must include the
IRS 1040 page with the signature and occupation of your spouse.
- If you and your spouse file separately, a copy of the spouse's
IRS 1040 must be included.
- If you file electronically you must include a copy of the
page showing the detailed information. This is often stamped
"file copy" by the preparer.
- You must include your spouse's income unless you were divorced
or filed a legal separation agreement, even though you may
file as "single, head of household" on your income tax return.
- If your spouse was in prison during the year and had no
income, please provide proof of your spouse's incarceration
or a notarized statement indicating the location of the
incarceration. Please include the prison phone number and
your spouse's inmate number so the prison may be called
to verify the information.
- If your spouse did not have enough income to have to file
a tax return, submit a copy of his or her W-2 form(s).
4. Give your application to your payroll officer to be completed.
You must attach a copy of your federal income tax return. Be sure
to allow enough time for your payroll officer to complete the
form and send it to DAS Benefits Administration
Services no later than April 15.
Filing Deadline
In order to be accepted, your application and completed tax form
must be date-stamped in Benefits Administration Services by April
15, or postmarked by April 15. No extensions will be given unless your application is under appeal on April 14. Applications submitted without the IRS income tax form, or without
the necessary information concerning expenses and your provider,
cannot be processed.
DAS Benefits Administration Services will return your application to you if it is incomplete. It is your
responsibility to submit all required documentation by April 15
to qualify for the benefit payment.
If you have questions about the Child Care Voucher Program, please
speak with your agency's payroll officer or contact Benefits Administration
Services through HCM Customer Service at 1-800-409-1205. |
