N.H. Code Admin. R. He-C 6912.11
(a) For foster care parents to be eligible to be enrolled as a license-exempt child care provider the foster parent shall meet the following qualifications:
(b) For a license-exempt facility-based program to be eligible to be enrolled, a child care provider shall meet the following qualifications:
(6) Comply with:
(c) For a licensed child care provider to be eligible to be enrolled, a child care provider shall meet the following qualifications:
(d) In addition to the requirements in He-C 6912.11(a), (b), and (c) above, a child care provider seeking to be enrolled shall submit every 3 years to DHHS for each child care location the following:
(1) If a licensed child care provider:
e. Form 2679 “Provider Web-Billing User Account Request” (November 2016), with the following understandings:
(2) If licensed as a foster care provider pursuant to He-C 6446:
e. Form 2679 “Provider Web-Billing User Account Request” (November 2016) with the following understandings:
(3) If a license-exempt facility based child care program as defined in RSA 170-E:3, I(a), (b), (f), and (g):
b. Form 2505 “A Background Check Information and Authorization” (February 2017) certifying the following:
“I understand the Division for Children, Youth and Families, Child Development Bureau will conduct a background check to include but not limited to: NH State Police Criminal Records (age 18 and older); Fingerprint-based criminal record check of the FBI national database (age 18 and older); check of the state and national sex offender registry and; a central registry for child abuse and neglect check (12 years or older) for every state lived in for the past 5 years. This is in accordance with RSA 170-E:3-a, 170-E;7 and federal laws (Adam Walsh Act and Megan’s Law), and is required for all individuals who ae employed or volunteer for licensed-exempt child care center, and who have contact with the children whose care I receive child care reimbursement from the Department.
I understand that the Division for Children, Youth and Families, Child Development Bureau shall check the National and State Sex Offender Registries, the DCYF Central Registry Name Search and the NH State Police Criminal Records and FBI database.
I understand that I am required to complete and submit a notarized NH Health and Human Services Criminal History Records Information Authorization (DSSP372) and a notarized DCYF Central Registry Name Search Authorization (Form 2503) and that my name will be received against the National and State Sex Offender Registries.
I understand that every member of my household, employee or volunteer age 12 and older will submit a notarized DCYF Central Registry Name Search Authorization (Form 2503) and their names will be reviewed against the National and State Sex Offender Registries.
I understand that every member of my household, employee or volunteer age 18 and older will submit a notarized NH Health and Human Services Criminal Record Information Authorization (DSSP372).
I understand that I am required to complete and submit any other background check information forms as required by any state that I have lived in during the past 5 years.
I understand that every member of my household, employee or volunteer age 18 and older is requested to complete and submit any other background check information forms as required by any state that they have lived in during the past five years.
I understand that I am required to complete and submit a new Background Check Information Form (2505) and all required authorizations on the first day that any information in this form changes. For example: someone moves into your home or begins to have contact with children.
I certify that all information on this form is true and complete. Providing falsified information may be grounds for denying enrollment”.;
f. Form 2679 “Provider Web-Billing User Account Request” (November 2016), with the following understandings:
(e) All license-exempt child care providers shall complete and submit, at the time of the live scan fingerprint appointment, notarized Form DSSP372 “New Hampshire Health and Human Services Criminal History Record Information Authorization,” (10/1/16) once every 5 years authorizing DHHS to receive fingerprint and criminal background checks for the provider and all household members, an individual identified in He-C 6920.04(a), and:
(g) Each license-exempt child care provider and each employee providing supervision of children or required to meet staff-to-child ratios, shall submit proof according to (l) below that the provider and employee has completed a minimum of 6 hours of training in all required health and safety topics as follows:
(j) Each license-exempt child care provider and employee providing supervision of children or required to meet staff to child ratios, shall submit to DHHS proof according to (l) below that the provider and each employee has current certification in:
(l) Each license-exempt provider and employee shall obtain documentation of successful completion of the training in (g) above that includes the following:
(n) Each license-exempt child care provider and employee shall complete the required health and safety training and certification in (g) and (j) as follows:
(r) The child care provider shall submit the applicable forms and documentation listed in this section by email to DCYF providerrelations@dhhs.nh.gov or by mail to:
Department of Health and Human Services
DCYF Provider Relations
129 Pleasant Street
Brown Building 3rd Floor
Concord, NH 03301
(w) All forms and documentation applicable to the child care provider shall be submitted according to Table 6912.1 below:
Table 6912.1
Forms and Documentation Required for Protective Child Care Enrollment
Form or Document
Licensed
License-Exempt
Licensed Foster Parent
Copy of current N.H. child care license
X
*
*
Copy of current Foster Care license
*
*
X
Form 1860 “Child Care Provider Agreement”
(May 2020 )
X
X
X
Form 1862 “Child Care Provider Enrollment Form” (May 2020)
X
X
X
“State of NH Alternate W-9 Form” (October 2016)
X
X
X
Form 2679 “Provider Web-Billing User Account Request” (November 2016)
X
X
X
“Form 2503 DCYF Central Registry Name Search Authorization”
(October 2016)
*
X
*
Form 2505 “Background Check Information and Authorization”
(February 2017)
*
X
*
DSS P372 “NH Health and Human Services Criminal History Record Information Authorization” (10/1/16)
*
X
*
Health and Safety Training Documentation
*
X
*
First Aid Certification
for Pediatric
*
X
*
Pediatric CPR Certification
*
X
*
Source. #13064, eff 7-1-20