CHILD CARE SUBSIDY DOCUMENTATION …

1 Eligibility FactorTo prove this factor, provide ONE (1) of the following:Eligibility FactorTo prove this factor, provide ONE (1) of the following:Photo ID;Driver's license; Passport;Birth Certificate;Naturalization certificate;Hospital / Doctor's Records; Adoption paperBirth certificate; Passport;Hospital records;Birth certificate(s); Hospital / Doctor's Records; Adoption Paper; Legal documents giving you Guardianship of the CHILD (ren) Marriage / Death certificate; Separation agreement;Divorce decree; Social Security records; Death certificate; Survivor's benefits.

2 Hospital records;VA or military record;Divorce papers;Proof of remarriage;Family Court order or statement;Insurance company record;Statement from person paying support;Incarceration record;Check stubs;Signed statement from professionalCurrent award certificate DSS Absent Parent Information form;ID cards (Health Insurance);Check stubsMARITAL STATUS You must prove if you are married, divorced, separated or recordsABSENT PARENT If the parent of any CHILD (ren)in your home is NOT living with you, you must prove this UNEARNED INCOME ( DOCUMENTATION varies based on source) Monetary determination letters.

3 Social Security or VA records Official correspondence from Veterans Affairsfrom Veteran's BenefitsCurrent benefit check Official correspondence from NYS DOLfrom CHILD Supportfrom Retirement / Disability Pensionsfrom Unemployment Insurance (UIB) CHILD care SUBSIDY DOCUMENTATION REQUIREMENTS You are required to provide proof of the information you provide on your application for a CHILD care SUBSIDY .

4 The documents identified below are acceptable forms of proof for the factors shown. There may be additional forms of DOCUMENTATION that would be acceptable. Your assigned DSS worker can answer questions you may have. Suffolk County Department of Social Services' CHILD care Unit can be reached at (631) 'S AGE & RELATION TO APPLICANT You must prove the CHILD 's age and your relationship to the CHILD (ren)

5 For whom you are requesting a CHILD care subsidyIDENTITY You must prove who you are EARNED INCOME ( DOCUMENTATION varies based on source) DSS Verification of Residence form - must be signed by your landlord (if not related) or other professional; Current rent receipt or lease that includes your name and addressCITIZEN STATUS You must prove the CHILD (ren) in need of a CHILD care SUBSIDY are citizensMortgage records; School records; Current mail bearing your name and address (utility bill, credit card bill, etc.)

6 Signed statement from your landlord (if a non-relative) or another professional that includes your name and address RESIDENCE You must prove where you liveDocumentation can be submitted by: Fax: (631) 854-3331 Email: Mail: SCDSS - FCSA CHILD care Unit Box 18100 Hauppauge, NY 11788 EXCEPTION: Documents that require an original signature (example.)

7 The CHILD care application) MUST be mailed to SCDSS ABSENT PARENT (Continued) You must provide any information you have regarding the absent parent (name, address, phone Social Security #, Birthdate, Employment, and Availability to provide CHILD care for children in common)

8 * DOCUMENTATION list is continued on the back of this page Official correspondence from Retirement systemOfficial correspondence from Social Security Administration; Current award certificate; Current benefit checkfrom Social Security Benefits including SSIA bsent parent's pay stub showing address;Tax returns; Social Security or VA records.

9 Driver's license or registration from an employerDSS Confidential Inquiry on Employment form completed and signed by your employer; Current pay stubs; Pay envelopes; Work schedule showing days Signed statement from employer (stating rate of pay per hour, # hours worked per week, date of first pay if newly employed, and; employer's name & phone #)from self employmentSCDSS Self Employment Worksheet (with supporting DOCUMENTATION ); Tax record.

10 Business records and related materials concerning earnings & expenses (incl. bills) from rent or room / boardCurrent contribution check; Statement from roomer / boarder/ tenant; Current Income tax recordsELIGIBILITY- SPECIAL NEEDS CHILD you must prove your CHILD has special needsTo prove this factor, provide ONE (1) of the following: ORORD ocumentation Needed:IMPORTANT NOTE:Pr