In order for an application to be approved, the applicant shall provide DHHS with verification of eligibility requirements within 30 days of the application date as follows:

1. (a) The name of each member of the assistance group shall be verified by one or more of the following documents:

   1. (1) The individual’s birth certificate;
   2. (2) The individual’s marriage certificate;
   3. (3) The individual’s divorce decree, if the name to be used is changed subsequent to a divorce;
   4. (4) The individual’s driver’s license or other identification which contains a picture of the individual; or
   5. (5) If the individual has had a legal name change, the court documentation showing the legal name of the individual and the date the name change took effect;

2. (b) The date and place of birth of each child in the assistance group for which the parent is requesting child care scholarship shall be verified by one or more of the following documents:

   1. (1) The child’s birth certificate;
   2. (2) The child’s baptismal certificate; or
   3. (3) The child’s US passport;

3. (c) When a child was not born in the US but has either become a US citizen or been lawfully admitted to the US, the child’s birth record and one or more of the following documents shall be submitted to verify date and place of birth and citizenship status:

   1. (1) The child’s certificate of citizenship or naturalization; or

   2. (2) The following US Citizenship and Immigration Services (USCIS) forms or documentation:

      1. a. USCIS Form I-551, Permanent Resident card;
      2. b. USCIS Form I-327, Re-entry Permit;
      3. c. USCIS Form I-94, Arrival Departure Record, stating that the child has been admitted to the US as a refugee under Section 207(c) of the Immigration and Nationality Act;
      4. d. USCIS Form I-94, Arrival Departure Record, stating that the child has been admitted to the US as an asylee under Section 208 of the Immigration and Nationality Act; or
      5. e. Documentation from USCIS that the child has lawful temporary or permanent resident status under Section 201 or 302 of the Immigration Reform and Control Act;

4. (d) The relationship of the parents in the assistance group to the child in the assistance group shall be verified by one or more of the following:

   1. (1) The child’s birth certificate containing the names of the child’s parents;
   2. (2) The parent’s birth certificate;
   3. (3) A marriage certificate containing the names of the parties who were married, including any maiden or previous names used;
   4. (4) Any additional birth, adoption, or marriage records necessary to show the relationship of the child to the parents in the assistance group;
   5. (5) For a legal guardian, the court documentation indicating the relationship of the adult to the child as that of a legal guardian; or

   6. (6) For a caretaker relative, one or more of the following documents:

      1. a. A court order giving the caretaker relative the duty of care, custody, and supervision of the child;
      2. b. A document showing power of attorney for the child by the caretaker relative with whom the child lives; or
      3. c. A statement from the child’s biological or adoptive parent that the caretaker relative is the individual who shall provide care and supervision for the child on the parent’s behalf;

5. (e) To verify a current address, any of the following verifications which show the address of the family shall be acceptable:

   1. (1) Rental receipts;
   2. (2) Utility bills;
   3. (3) A statement from the current landlord;
   4. (4) An unexpired lease or rental agreement; or
   5. (5) If the home is owned, the deed or mortgage statements;
6. (f) Self-attestation shall be an acceptable form of verification for children of migrant workers experiencing homelessness because they are living in circumstances described in He-C 6910.03(h);

7. (g) Monthly gross income of each member of the assistance group shall be verified in accordance with He-W 744.01 or He-W 744.03, or as follows:

   1. (1) For self-employment, the parent’s entire IRS tax filing from the previous year if filed, or a complete profit and loss statement for the previous year, as described in He-C 6910.06(d);
   2. (2) Any contributions of monies to the assistance group from any source, verified by a signed statement from the contributor, which indicates the amount, frequency, and expected end date of the contribution, as well as whether the contribution is considered to be a loan or a gift;
   3. (3) For earned income that fluctuates month-to-month according to He-C 6910.06(g)(1), pay stubs, a written statement from the employer stating the average monthly amount earned, or a collateral contact, as defined in He-C 6910.03, with the employer;
   4. (4) For unearned income that fluctuates according to He-C 6910.06(g)(2), a written statement from the contributor, physical documentation, or a collateral contact with the contributor;
   5. (5) For earned income that fluctuates season-to-season according to He-C 6910.06(g)(3)b., either the previous year’s tax return and W-2, a statement from the employer, or a collateral contact with the employer; or
   6. (6) For income that cannot be verified according to (1)-(5) above, and which is anticipated to fluctuate over the next 12-month period, verification shall consist of a statement from the employer identifying an estimate of future earnings during the upcoming 12-months;
8. (h) The applicant shall attest that the assistance group’s resources, including both personal and real property, do not exceed $1,000,000 dollars in assets. No member of the assistance group shall have, nor shall the combined assets of the assistance group be, equal to or greater than $1,000,000, pursuant to 45 CFR 98.20(a)(2)(ii);
9. (i) To establish a link between the applicant child and the enrolled child care provider, the parent and the enrolled child care provider shall complete, sign and date, and submit to the DO Form 1863 “Child Care Provider Verification,” (October 2023);

10. (j) The following verification requirements shall apply for a child experiencing a disability or significant special need requiring additional funds for accommodations or classroom adaption in the child care setting:

    1. (1) The parent shall authorize the release of information to DHHS by completing section III of Form 2690 “Verification for a Child Experiencing a Disability or Significant Special Need,” (October 2023), and by signing and dating the form, affirming the following:

       “By signing below, I authorize this verification to be released to the Department of Health and Human Services. I understand that the information will be held in the strictest of confidence and that it will be reviewed by, or shared with, authorized Department of Health and Human Services’ staff involved in the authorization of Child Care and Development Fund Scholarships”; and

    2. (2) The enrolled child care provider shall complete section I of Form 2690, “Verification for a Child Experiencing a Disability or Significant Special Need” (October 2023), including signing and dating the form, certifying the following:

       1. a. “I certify that the child’s disability or special need(s) is significant enough that the child requires additional funds for accommodation or classroom adaptation in the child care setting.”; and
       2. b. “I agree to submit an annual report to DHHS specifying how the monies were spent which include all DHHS requested information necessary for program monitoring”;

    3. (3) A licensed professional shall complete section II of Form 2690, “Verification for a Child Experiencing a Disability or Significant Special Need,” (October 2023), including signing and dating the form, certifying that one of the following is applicable:

       1. a. “I certify that: I am the child’s attending physician, physician’s assistant, advance practice registered nurse, or licensed mental health professional and am providing ongoing treatment; the child’s disability or special need(s) is significant enough that the child requires additional support and/or accommodation in a child care setting; and, if the child is 13 through 17 years of age, the child’s condition limits the child’s ability to care for himself/herself or he/she would cause harm to himself/herself or others without supervision.”; or
       2. b. “I certify that I am a SAU Special Education Director or Area Agency Director and I believe that the child’s disability or special need(s) is significant enough that the child requires additional support and/or accommodation in a child care setting.”.

11. (k) When a parent in a 2-parent household claims that the parent has a disability, acceptable verification shall be a signed and dated statement from an attending physician, physician assistant (PA), advanced practice registered nurse (APRN), or licensed mental health professional (LMHP) indicating:

    1. (1) The medical condition, disease, or disability of the adult;
    2. (2) The expected duration of the condition, disease, or disability; and
    3. (3) That the parent is unable to work and to care for and supervise the parent’s children because of the specified condition, disease, or disability;

12. (l) For parents who are NHEP participants and are also in an approved training or educational program, including an online training or educational program, acceptable verification shall be a signed and dated statement from the school or training organization indicating:

    1. (1) The parent is enrolled in the program;
    2. (2) The duration of the program;
    3. (3) The class schedule, including hours of class attendance; and
    4. (4) The program shall lead to a degree, license, or certificate at the bachelor’s level or lower in a specific field of employment;

13. (m) For parents who are not receiving TANF financial assistance, but who are in an approved training or educational program, as described in He-C 6910.13(d), including an online training or educational program, acceptable verification shall be a signed and dated statement from the school or training organization indicating:

    1. (1) The parent is enrolled in the program;
    2. (2) The duration of the program;
    3. (3) The class schedule, including hours of class attendance; and
    4. (4) The program shall lead to a degree, license, or certificate at the associate’s level or lower in a specific field of employment;

14. (n) For parents receiving TANF financial assistance and not participating in the NHEP work program, as described in He-C 6910.13(e), acceptable verification of the training program or course of study, including an online training or educational program, shall be a signed and dated statement from the school or training organization indicating:

    1. (1) The requirements in (m)(1), (2), and (3) above; and
    2. (2) That the program shall lead to a degree, license, or certificate at the bachelor’s level or lower in a specific field of employment;
15. (o) When a parent works at least 4 hours between 10:00 p.m. and 6:00 a.m., acceptable verification shall be a signed and dated statement from the parent’s employer, or, if self-employed, a customer of the parent, stating the hours of the shift that the individual works each week;

16. (p) If at redetermination a parent is experiencing one of the circumstances in He-C 6910.10(n), the following verification shall be required:

    1. (1) A signed and dated statement from the employer that the parent is still employed and will be able to return to work following the medical leave, seasonal break in employment, or other temporary absence in accordance with 45 CFR 98.21(a)(1)(ii);
    2. (2) Proof of registration for the following semester, or a signed and dated statement from the institution where the parent attends the training or educational program, stating that the parent is still enrolled; or
    3. (3) A signed and dated statement from the mental health or substance misuse treatment program indicating that the parent is on a temporary absence from the program, but is still considered to be enrolled, if the parent is an NHEP or FAP recipient;

17. (q) When a parent is participating in job search at initial application or at redetermination, acceptable verification shall be:

    1. (1) Proof of receipt of unemployment compensation benefits;
    2. (2) A personal summary page from the NH department of employment security’s job match;
    3. (3) The verifications described in He-W 637.03(g) for participants in the NHEP work program; or
    4. (4) A completed BCDHSC Form 2693 “New Hampshire Child Care Scholarship Program Job Search Activity Verification Form,” (October 2023), if the parent is actively seeking employment independently;

18. (r) When a parent has a permanent job loss, acceptable verification shall be:

    1. (1) A signed and dated notice of termination from the employer;
    2. (2) Any other signed and dated verification from the employer that the parent is no longer employed; or
    3. (3) Collateral contact with the employer;

19. (s) The verification listed in (r) above shall include all of the following:

    1. (1) That the parent is no longer employed;
    2. (2) The last date the parent worked;
    3. (3) The date of termination;
    4. (4) The reason for termination;
    5. (5) The parent’s final pay date; and
    6. (6) The parent’s final 4 weeks’ gross pay;
20. (t) In order for the assistance group’s cost share to be recalculated during the eligibility period, the family shall verify any loss of employment or other income that results from the termination of the approved employment-related activities listed in He-C 6910.07(f);
21. (u) When a parent applying for expedited child care scholarship is experiencing homelessness as defined in the McKinney-Vento Homeless Assistance Act of 1987, as reauthorized in 2015, acceptable verification shall be a self-attestation from the parent that the family is experiencing homelessness;
22. (v) A parent may request additional hours towards their service level if they are participating in an employment-related activity as described in He-C 6910.07(f), experiencing homelessness, and seeking housing in the same week;
23. (w) When a parent meets the criteria in (v) above, acceptable verification for eligibility of additional hours towards their service level shall be a self-attestation stating that the parent is experiencing homelessness and documentation indicating how many hours per week the parent is seeking housing;
24. (x) For individuals who did not find an enrolled child care provider within 30 days when seeking child care through a child care resource and referral agency pursuant to He-C 6910.10(q)(1), acceptable verification shall be a letter from the child care resource and referral agency stating that the parent has been working with the referral agency staff and child care has not been identified for the specified child;
25. (y) When a child or parent has had an in-patient hospital stay within the past 30 days as described in He-C 6910.10(q)(2), acceptable verification of the in-patient hospital stay shall be the discharge statement, hospital record, or a statement from the attending physician;
26. (z) When a parent is engaged in an employment-related training or educational activity, as described in He-C 6910.07(f)(3), acceptable verification of satisfactory progress shall be a report card or signed and dated statement from the organization or agency, or the educational or training facility, indicating that the parent is making satisfactory progress as defined in He-C 6910.03(ap);

27. (aa) The following verification requirements shall apply to a parent receiving NHEP or FAP financial assistance while participating in a mental health or substance misuse treatment program:

    1. (1) The parent shall certify participation in an approved mental health treatment program or substance misuse treatment program and authorize the release of information to DHHS by completing, signing, and dating section I of Form 2691 “Verification Individual Participation in a Mental Health or Substance Misuse Treatment Program,” (October 2023) affirming the following:

       1. a. “By signing this form, I authorize the release of this information to the Department of Health and Human Services (DHHS). I understand information will be held in strictest confidence and will be reviewed by, or shared with, authorized DHHS staff involved in determining eligibility for the New Hampshire Child Care Scholarship program”; and
    2. (2) A licensed professional shall certify ongoing treatment is being provided by completing, signing, and dating section II of Form 2691 “Verification for Participation in a Mental Health or Substance Misuse Treatment Program,” (October 2023).
28. (ab) When a parent requests a decrease in service level, pursuant to He-C 6910.16(b)(2), acceptable verification shall be a signed and dated statement from the parent.

Source. #7357, eff 9-1-0000; ss and moved by #7723, eff 7-1-02 (from He-C 6910.07); amd by #8377, eff 6-21-05; (See Revision Note at part heading for He-C 6910) #9474, eff 6-29-09; amd by #10120, eff 5-7-12; amd by #10565, eff 4-4-14; amd by #10917, eff 9-1-15; ss by #12221, eff 7-10-17 (from He-C 68910.08); ss by #13063, eff 7-1-20; ss by #13799, eff 10-28-23; ss by #13951, eff 4-30-24