Licensing Forms - Fill-in Enabled
Versions
Each of the forms listed below can be filled out on-screen by (1) downloading and saving the document to your hard-drive, then (2) opening the document back up and typing the requested information into the gray fields provided next to the items on the form. These forms are "protected" to allow you to move from field to field simply by pressing the TAB key on your keyboard. (NOTE: If you unprotect a form, it will lose this "tab-to-field" ability. To restore that ability, you will need to go to "Tools" on your main toolbar and select "Protect Document.")
When you have completed the form, you can either print it out and send it to your OCC Regional Licensing Office, or e-mail it to your Regional Licensing Office as an attachment if it does not require an original signature. As a precaution, we recommend that you save the completed form on your hard-drive before printing it out or attaching it to an e-mail.
Important: Some of the forms below require one or more original (i.e., hand-written) signatures. Before you submit a form to your Regional Licensing Office, please make sure that it has all the necessary signatures.
After each form below, one of the the following indicators is used to show what type of child care facility the form is used for:
· (HOME) - family child care homes
· (CTR/LOC) - child care centers and letter of compliance facilities
· (CTR) - child care centers only
· (LOC) - letter of compliance facilities only
· (ALL) - centers, homes, and letter of compliance facilities
If you have any questions about the use of a form, please contact your Regional Licensing Office.
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Form Number |
Title/Description |
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100 |
Professional Development Plan (CTR) |
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101A |
Professional Development Plan-1st Year(HOME) |
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101B |
Professional Development Plan-Continuing (HOME) |
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101C |
FDC Applicant – Initial Training Requirements (HOME) |
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349 |
Application to Resume Service (HOME) |
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670 |
Announced Inspection Preparation Checklist - Child Care Centers and Letter of Compliance Facilities (CTR/LOC) |
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671 |
Announced Inspection Preparation Checklist - Family Child Care Homes (HOME) |
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672 |
Request for Continuing License or Letter of Compliance (CTR/LOC) |
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673 |
Request for Continuing Registration (HOME) |
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1200 |
Application - Initial (CTR/LOC) |
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1201 |
Insurance Information (CTR/LOC) |
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1203 |
Personnel List & Staff Change Report (CTR/LOC) |
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1204 |
Medical Report for Child Care (ALL) |
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1205 |
Personnel Information (CTR) |
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1206 |
Staffing Pattern (CTR/LOC) |
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1209 |
Changes in Facilities (CTR/LOC) |
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1213 |
Variance Request (ALL) |
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1215 |
Health Inventory (ALL) |
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1216 |
Medication Administration (ALL) |
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1218 |
Menu Plan (CTR/LOC) |
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1229 |
Substitute Form (HOME) |
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1230 |
Application - Initial (HOME) |
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1260 |
Release of Information (ALL) |
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1261 |
Emergency Escape Plan (HOME) |
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1267 |
Provider Information & Plan of Operation (HOME) |
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1268 |
Environmental Health Survey (ALL) |
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1270 |
Notice of Intent to Operate (CTR/LOC) |
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1275 |
Additional Adult Application (HOME) |
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1281 |
Request for Hearing (ALL) |
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1285 |
Health History - Drop -in (CTR) |
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1295 |
Self - Assessment Guide (HOME) |