N.H. Code Admin. R. He-C 6920.10 – Appeals

(a) An applicant or provider may appeal a decision made by the department within 10 business days of the receipt of the notification when:
1. (1) The application for enrollment has been denied;
2. (2) Payments have been withheld; or
3. (3) Enrollment has been revoked or not renewed.
(b) The request for an appeal shall be made in accordance with He-C 200.
Source. #7939, eff 8-23-03; ss by #9979, INTERIM, eff 8-23-11, EXPIRES: 2-21-12; ss by #10088, eff 2-21-12 (from He-C 6920.13); ss by #13401, eff 7-1-22 and by #14095, EMERGENCY RULE, eff 10-9-24; ss by #14222, eff 3-27-25, EXPIRES: 3-27-35
APPENDIX
Rule
Specific State or Federal Statutes or Regulations the Rule Implements
He-C 6910.01
RSA 161:2, XII; RSA 167:83, I(b); RSA 167:83, II(o)
He-C 6910.02
RSA 167:77, V(e)
He-C 6910.03
RSA 161:2, XII; RSA 167:58, IV; RSA 167:83, I(b); RSA 167:83, II(o); RSA 167:84; RSA 170-E:3; RSA 170-E:6-a
He-C 6910.04
RSA 167:79, III(d)–(g); RSA 167:83, II(o)
He-C 6910.05
RSA 161:2, XII; RSA 167:80, IV(b) and (i); RSA 167:83, II(o)
He-C 6910.06
RSA 167:83, II(c) and (o)
He-C 6910.07
RSA 161:2, XII; RSA 167:80, IV(b) and (i); RSA 167:82, VI; RSA 167:83, II(o),(q)
He-C 6910.08
RSA 167:7, VI; RSA 167:85; RSA 167:88; RSA 167:90;
RSA 167:91
He-C 6910.09
RSA 167:83, II(c) and (o); 45 CFR 98.20(a)(2)(ii)
He-C 6910.10
RSA 167:79, V(b); RSA 167:83, II, (c),(e),(m)
He-C 6910.11
RSA 167:83, II(b); RSA 167:83, III(h)
He-C 6910.12
RSA 161:2, XII; RSA 167:83, II
He-C 6910.13
RSA 167:83, II(o)
He-C 6910.14
RSA 167:83, II(c) and (o)
He-C 6910.15
RSA 161:2, XII; RSA 167:83, II
He-C 6910.16
RSA 161:2, XII; RSA 167:83, II
He-C 6910.17
RSA 167:83, II(o); 45 CFR 98.45
He-C 6910.18
RSA 161:2, XII; RSA 167:83, II(o); RSA 167:83, III(g);
RSA 170-E:3-a; RSA 170-E:4, II; RSA 170-E:7; RSA 170-E:12
He-C 6910.19
RSA 167:83, II(a); RSA 541-A:31, I and II
He-C 6910.20
RSA 170-E:11, I(m)
He-C 6912.01
RSA 161:2, RSA 167:83, I(b); and RSA 170-G:4, II, III
He-C 6912.02
RSA 161:2, RSA 167:83, I(b); and RSA 170-G:4, II, III
He-C 6912.03
RSA 161:2, RSA 167:83, I(b); and RSA 170-G:4, II, III
He-C 6912.04
RSA 161:2, RSA 167:83, I(b); and RSA 170-G:4, II, III
He-C 6912.05
RSA 161:2, RSA 167:83, I(c); and RSA 170-G:4, III, VI
He-C 6912.06
RSA 161:2, XII ; RSA 167:83, II(o); RSA 170-E:3-a;
RSA 170-E:4, II; RSA 170-E:7; RSA 170-E:11; RSA 170-E:12; RSA 170-G:4, XVIII; and RSA 170-G:5
He-C 6912.07
RSA 161:2, XII ; RSA 167:83, II(a), (o); RSA 170-E:3-a;
RSA 170-E:4, II; RSA 170-E:7; RSA 170-E:11; RSA 170-E:12; RSA 170-G:4, VIII, XVIII; RSA 170-G:5; and RSA 541-A:31, I and II
He-C 6912.08
RSA 170-E:11; RSA 170-G:4, XVIII; and RSA 170-G:5
He-C 6912.09
RSA 161:2, RSA 167:83, I(b); and RSA 170-G:4, II, III
He-C 6912.10
RSA 161:2, RSA 167:83, I(c); and RSA 170-G:4, III, VI
He-C 6912.11
RSA 161:2, XII ; RSA 167:83, II(o); RSA 170-E:3-a;
RSA 170-E:4, II; RSA 170-E:7; RSA 170-E:11; RSA 170-E:12; RSA 170-G:4, XVIII; and RSA 170-G:5
He-C 6912.12
RSA 161:2, XII ; RSA 167:83, II(a), (o); RSA 170-E:3-a;
RSA 170-E:4, II; RSA 170-E:7; RSA 170-E:11; RSA 170-E:12; RSA 170-G:4, VIII, XVIII; RSA 170-G:5; and RSA 541-A:31, I and II;
He-C 6912.13
RSA 170-E:11; RSA 170-G:4, XVIII; and RSA 170-G:5
He-C 6912.14
RSA 161:2, XV; RSA 167:17-b, I(a); RSA 167:17-c;
RSA 167:58, IV; RSA 167:61-a, I(a)-(c) and (e);
RSA 167:83, II(k); RSA 170-E:7; RSA 170-E:11;
RSA 170-E:12; RSA 170-G:4, XVIII; and RSA 170-G:5
He-C 6912.15
RSA 161:2, XII; and RSA 170-G:4, II, III
He-C 6912.16
RSA 161:2, XII; and RSA 170-G:4, XVII
He-C 6912.17
RSA 167:83, II(a); RSA 170-E:11; RSA 170-G:4, VIII;
RSA 170-G:4, XVIII; RSA 170-G:5; and RSA 541-A:31, I and II
He-C 6912.18
RSA 167:83, II(a)
He-C 6912.19
RSA 170-E:11, II; RSA 170-G:8-a
He-C 6912.20
RSA 170-E:11, I (m)
He-C 6914.01
RSA 161:2, XII; RSA 170-E:11; RSA 170-G:4, XVIII; RSA 170-G:5
He-C 6914.02
RSA 161:2, XII; RSA 167:83, II(o); RSA 170-E:11; RSA 170-G:4, XVIII; RSA 170-G:5
He-C 6914.03
RSA 161:2, XII; RSA 167:58, IV; RSA 170-G:4, XVIII; RSA 170-G:5
He-C 6914.04
RSA 161:2, XII; RSA 167:83, II(a)-(o); RSA 170-E:3-a; RSA 170-E:4, II; RSA 170-E:7; RSA 170-E:11; RSA 170-E:12; RSA 170-G:4, VIII, and XVIII; RSA 170-G:5; RSA 541-A:31, I and II
He-C 6914.05
RSA 161:2, XII; RSA 167:83, II(a), (o); RSA 170-E:3-a; RSA 170-E:4, II; RSA 170-E:7; RSA 170-E:11; RSA 170-E:12; RSA 170-G:4, VIII, and XVIII; RSA 170-G:5; RSA 541-A:31, I and II
He-C 6914.06
RSA 170-E:11; RSA 170-G:4, XVIII; RSA 170-G:5
He-C 6914.07
RSA 161:2, XV; RSA 167:17-b, I(a); RSA 167:17-c; RSA 167:58, IV; RSA 167:61-a, I(a)-(c) and (e); RSA 167:83, II(k); RSA 170-E:7; RSA 170-E:11;RSA 170-E:12; RSA 170-G:4, XVIII; RSA 170-G:5
He-C 6914.08
RSA 167:83, II(a); RSA 170-E:11; RSA 170-G:4, VIII; RSA 170-G:4, XVIII; RSA 170-G:5; and RSA 541-A:31, I and II
He-C 6914.09
RSA 167:83, II(a)
He-C 6914.10
RSA 170-E:11, II; RSA 170-G:8-a
He-C 6914.11
RSA 170-E:11, I (m)
He-C 6915 - Reserved
He-C 6916
RSA 161:2, XII; RSA 161:4-a, III; RSA 170-E:3, I(f) and (g); RSA 170-E:6-a; RSA 170-E:10-a; RSA 170-E:11; RSA 170-G:4, XVIII; RSA 170-G:5; 45 CFR 98.41; and 45 CFR 98.42
He-C 6917
RSA 161:2, XII; RSA 161:4-a, III; RSA 170-E:3, I(c) & (h); RSA 170-E:6-a; RSA 170-E:10-a; RSA 170-E:11; RSA 170-G:4, XVIII; RSA 170-G:5; 16 CFR 1219; 16 CFR 1220; 45 CFR 98.41; and 45 CFR 98.42
He-C 6918.01
RSA 167:77
He-C 6918.02
RSA 161:2, XII; and RSA 167:83, I(b)
He-C 6918.03
RSA 167:83, I(b)
He-C 6918.04
RSA 167:83, II(o); and 45 CFR 98
He-C 6918.05
RSA 161:2, XII; and RSA 167:83, II; and 45 CFR 98
He-C 6918.06
RSA 161:2, XV; RSA 167:17-b, I(a); RSA 167:17-c;
He-C 6918.07
RSA 161:2, XII; RSA 167:83, II(a); and RSA 170-G:4,a.
He-C 6918.08
RSA 167:83, II(i); RSA 167:17-b, I(a); RSA 167:17-c; RSA 167:58, IV; RSA 167:61-a, I(a)-(c), and (e); RSA 167:83, II(k); RSA 170-E:7; and RSA 170-E:12, V
He-C 6918.09
RSA 170-E:11, II; and RSA 170-G:8-a
He-C 6918.10
RSA 170-E:11, I (m)
He-C 6920.01
RSA 170-E:3-a; RSA 170-E:7
He-C 6920.02
RSA 170-E:3, I (a) – (h)
He-C 6920.03-He-C 6920.10
RSA 170-E:3-a; RSA 170-E:7
NAME OF CHILD CARE PROGRAM/PROVIDER: DATE OF CHILD’S ENROLLMENT:

PROVIDER #: RID #:
TO THE PARENT OR GUARDIAN: This form must be completed for each of your children who will be enrolled in the program, and must be updated whenever information changes.
Child’s full legal name:
Child’s Date of birth:
IDENTIFYING INFORMATION OF PARENTS OR GUARDIANS LEGALLY RESPONSIBLE FOR CHILD:
Name:
Name:
Physical Address:
Physical Address:
Mailing Address (if different):
Mailing Address (if different):
Phone number:
Phone number:
Email:
Email:
Indicate where the parents/guardians above can be reached while the child is in care. Include name, address and phone number of business if applicable. Include any special instructions, for example cell phone, etc.
Business Name:
Business Name:
Address:
Address
Phone number: Hours:
Phone number: Hours:
Email:
Email:
Special Instructions for reaching parent/guardian:
EMERGENCY CONTACT PERSON: You (parent/guardian) are required to list at least one emergency contact person you feel comfortable leaving your child with, and who could pick your child up if you could not be reached immediately in an emergency, or if you could not pick up your child and were unable to communicate with the provider/program. For example, if your child is sick and provider/program is unable to reach you.
Name:
Name:
Relationship:
Relationship:
Address:
Address:
Phone number:
Phone number:
.NON-EMERGENCY ALTERNATE PICK-UP PERSON/S: I,
(Parent/Guardian Signature)
authorize the following individual(s) to pick up my child from the program on a non-emergency basis.
Name:
Name:
Relationship:
Relationship:
Address:
Address:
Phone number:
Phone number:
MEDICAL INFORMATION
Any chronic conditions, allergies or medications to be administered in the event of sudden illness or injury:
Child’s Physician: Phone number:
Physician’s Address:
EMERGENCY MEDICAL TREATMENT AUTHORIZATION
I hereby give permission for (name of provider/program) to provide first aid treatment to my child, when necessary. In the event of a more serious illness or injury, I give permission for my child to be transported to a hospital or other emergency medical facility to receive emergency medical treatment. I also authorize ambulance/rescue squad attendants to administer such treatment as is medically necessary, and I authorize licensed health practitioners working in the hospital or emergency medical facility to examine and provide emergency medical treatment to my child if warranted. I understand that I will be contacted by the provider or program staff as soon as possible regarding any emergency involving my child.
Parent/Guardian Signature
Date
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ANNUAL UPDATE: Make necessary changes & initial & date below to verify that the information is current.
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Parent/Guardian Initials: Date:
Parent/Guardian Initials: Date:
Parent/Guardian Initials: Date: