Great Start to Quality Orientation: Level 1 of Michigan s Quality Development Continuum

Great Start to Quality Orientation: Level 1 of Michigan s Quality Development Continuum Revised: Oct. 2018

1 2 3 4 5 6 7 Training Overview and Great Start to Quality Child Development and Learning Shared Expectations Health, Safety, and Nutrition Additional Resources CPR First Aid Level 2 Training 8

Great Start to Quality Orientation: Level 1 of Michigan s Quality Development Continuum Great Start to Quality Level 1 Orientation Training www.greatstarttoquality.org Let s Talk Details Signing in Bathrooms Food Breaks Resource Binder www.greatstarttoquality.org

Why do I need to attend this training? What s in it for me? How a Child s Brain Develops www.greatstarttoquality.org By the end of today, you will know how to: Be a Brain Builder! Prevent, plan for and respond to common health and safety issues. Deal with the common stresses and frustrations of caring for children. www.greatstarttoquality.org

By the end of today, you will know how to: Access more training so you can learn new things and also increase your payment. Handle medical emergencies with CPR and emergency first aid. www.greatstarttoquality.org Working Agreements Ask questions if needed Share your knowledge Listen to and respect other s opinions Turn off cell phones or put on vibrate Others? www.greatstarttoquality.org Getting to know you My name is I take care of child(ren). She/He/They are old. I ve been caring for children for months/years I enjoy caring for children because. www.greatstarttoquality.org

Michigan s Quality Rating and Improvement System 20 hours of Level 2 training and a Completion minimum of of Level 1 10 hours Completion and 10 hours implementing of Great of Level 2 an approved approved Start to Quality core trainings Quality Improvement annually. Orientation. Plan.. Level 1 Level 2 Level 3 Program meets licensing requirements. Program meets licensing requirements and is participating in Great Start to Quality. Program demonstrates quality across some categories of program quality indicators. Program demonstrates quality across several categories of program quality indicators. Program demonstrates quality across almost all categories of program quality indicators. Program demonstrates high quality. Program demonstrates highest quality. License Exempt Providers Licensed programs serving children ages 0-12 Working as an License-Exempt Child Care Provider What you Must Know Section 1 in Binder contains key documents Provider Enrollment how do I complete the enrollment process? Questions about billing www.michigan.gov/childcare or 866.990.3227 Child Development and Care (CDC) Program Rules how do I learn the rules of this program? www.greatstarttoquality.org

Level 2 Training Taking 10 hours of Level 2 training will increase your subsidy rate. Level 2 Training Topics: Child Development Interactions and Guidance Family and Community Engagement Observation, Documentation and Assessment Health, Safety and Nutrition Teaching and Learning Professionalism Management www.greatstarttoquality.org Payment The current Level 1 rate is: $1.60 an hour per child. The current Level 2 rate for children under 2 ½ is: $2.95 an hour per child. The current Level 2 rate for children over 2 ½ up to age 12 is $2.60 an hour per child. Example: a provider serving a 12 month old, a four year old and a 10 year old for 40 hours a week could earn At Level 1: $384 every two weeks At Level 2: $652 every two weeks www.greatstarttoquality.org

Toll-free: 1.877.614.7328 Visit: www.greatstarttoquality.org Start here for Quality Early Childhood Education Houghton Keweenaw Resource Center Service Areas Ontonagon Baraga Gogebic Iron Marquette Alger Schoolcraft Luce Chippewa Dickinson Delta Mackinac Menominee Emmet Cheboygan Presque Isle Leelanau Charlevoix Antrim Otsego Montmorency Alpena Benzie Grand Traverse Kalkaska Crawford Oscoda Alcona Manistee Wexford Missaukee Roscommon Ogemaw Iosco Mason Lake Osceola Clare Gladwin Arenac Oceana Newaygo Mecosta Isabella Midland Bay Huron Muskegon Montcalm Gratiot Saginaw Tuscola Sanilac Ottawa Kent Ionia Clinton Shiawassee Genesee Lapeer St. Clair Allegan Barry Eaton Ingham Livingston Oakland Macomb Van Buren Kalamazoo Calhoun Jackson Washtenaw Wayne Berrien Cass St. Joseph Branch Hillsdale Lenawee Monroe 10 Great Start to Quality Resource Centers serving 11 Regions 9.27.18 Funding from the Office of Great Start within the Michigan Department of Education supports the implementation of Great Start.

Completion of Great Start to Quality Orientation.. Completion of Level 1 and 10 hours of Level 2 approved core trainings annually. 20 hours of Level 2 training and a minimum of 10 hours implementing an approved Quality Improvement Plan. Program meets licensing requirements. Program meets licensing requirements and is participating in Great Start to Quality. Program demonstrates quality across some categories of program quality indicators. Program demonstrates quality across several categories of program quality indicators. Program demonstrates quality across almost all categories of program quality indicators. Program demonstrates high quality. Program demonstrates highest quality.

For Support with License Exempt Provider Application and Billing Child Development and Care Customer Service Contact us at 866.990.3227 Press 1 - License Exempt provider enrollment, address change, household member change Press 2 - Billing, payment or direct deposit issues Press 3 PIN, assignment or authorization issues Press 5 Criminal history matches

Child Development and Care (CDC) License Exempt Provider Application What type of provider is this application for? This application is for individuals who are applying to be enrolled by the State of Michigan as either a License Exempt-Related or License Exempt-Unrelated child care provider. See the table below to determine which provider type you are applying to be. License Exempt-Related Provider is related to the child as a: o Sibling (not living with the child) o Aunt or Great Aunt o Uncle or Great Uncle o Grandparent or Great Grandparent Provider and all household members (people 18 years or older who live with the provider) must pass a criminal history background check. Provider must complete a one-time Great Start to Quality Orientation training. License Exempt-Unrelated Provider is not related to the child (as listed for related). Provider must provide care in the child s home. Provider must pass a comprehensive background check and participate in an annual health and safety visit. Provider must complete a one-time Great Start to Quality Orientation training. How do I apply? Complete the application and submit it along with the required proofs to: Mail: Child Development and Care Program Provider Enrollment P.O. Box 30267 Lansing, MI 48909 Fax: 517-284-7529 A list of acceptable proofs can be found at: www.michigan.gov/childcare. Proofs include: Proof of your age. Proof of your identity. Proof of where you currently live. Copy of your valid Social Security card. Note: The name on the application and all proofs must match your current name. Am I required to take the Great Start to Quality Orientation, and how much does it cost? All license exempt-related and unrelated child care providers are required to take a one-time Great Start to Quality Orientation training to receive CDC payments. To register for this $10 training, visit www.miregistry.org or call 877-614-7328 as soon as possible to contact the resource center in your area. It is NOT necessary to wait until your application is processed before you sign up and complete the training. If you have taken this training before, you do not need to take it again. Revised 03.01.2019 MDE is an equal opportunity employer/program. 1

Child Development and Care (CDC) License Exempt Provider Application Instructions: This application should be completed and signed by the person who will be caring for the child(ren). To complete this application, you must: Send to: Child Development and Care Program Answer all applicable questions. Provider Enrollment Submit proof of your age. P.O. Box 30267 Submit proof of your identity. Lansing, MI 48909 Submit proof of where you currently live. or Submit a copy of your valid Social Security card. Fax: 517-284-7529 Sign and date the application on page 5. Sign and date the consent and disclosure on page 8. (Unrelated only) What happens after CDC receives my application and proofs? Your application will be reviewed by enrollment staff to ensure that everything we have received is complete and legible. If we do not receive a complete application, or if any of the documents we receive are not legible, we will notify you by mail. Once we have everything we need, you will be placed in line for your phone interview. Interviews and applications are processed in the order they are received. If we are not able to reach you when we attempt to call you for your interview, we will leave a message with the name of the person who will be conducting your interview and the number where you can reach them. If you have voice mail, be sure it is set up and has space for new messages so that you do not miss our call. IMPORTANT REMINDERS Please send black and white copies. Do not send originals, as they may not be returned. Snapshots taken with a cell phone are often not clear when they are faxed. Once we receive your complete application and proofs, you will be placed in line for your mandatory phone interview. We will contact you using the phone number you provided on your application. If we are unable to complete the phone interview, your application will be denied. Only submit your application and proofs to the Child Development and Care program, using the address or fax number provided on this application. If your application was submitted by fax, and you wish to confirm that it was received, you may call us at 866-990-3227 to confirm. Please allow at least 24 hours (not counting weekends and holidays) before you call to follow up. If the application was mailed, allow at least one week before you call us. Please review your application carefully before you submit it. Be sure that you have: o o o o Answered all applicable questions. Provided a contact number for your mandatory phone interview. Submitted copies of your proofs. Signed and dated your application. Revised 03.01.2019 MDE is an equal opportunity employer/program. 2

Child Development and Care (CDC) License Exempt Provider Application SECTION A: Provider Information (License Exempt-Related/Unrelated) Instructions: Provider, use this section to tell us about yourself. What type of child care provider are you applying to be? I am applying to become a License Exempt-Related provider (Only complete sections A, B and C.) I am applying to become a License Exempt-Unrelated provider (Only complete section A, C and D.) First Name Middle Name Last Name Gender Do you have a former name, maiden name or alias? No Yes If Yes, list all here: Date of Birth Driver License/ID Number Address where provider lives (Number, Street, Apt. Number) City State MI P.O. Box (only complete if you are using a P.O. Box for mail) City State MI Zip Code Zip Code County County Telephone Number (required) Social Security Number (SSN) Provider ID Number (if known) Have you ever had a license or registration suspended or revoked by LARA, BCHS, or MDHHS? No Yes If Yes, please explain why: Do you receive MDHHS payment for providing Adult Home Help Services? Note: Adult home help services cannot be provided during the same hours you are providing child care. No Yes Where do you provide child care? If Yes, list the person(s) you care for: In my home In the child s home I live with the child How you are related to the child(ren)? Have you lived outside of Michigan within the last 5 years? No Yes If Yes, please list your out of state address(es) in the area below. (Number and Street, Apt. Number) City State Zip Code County (Number and Street, Apt. Number) City State Zip Code County Revised 03.01.2019 MDE is an equal opportunity employer/program. 3

Child Development and Care (CDC) License Exempt Provider Application SECTION B: Household Member Information (License Exempt-Related only) Instructions: In the section below, list all adults (people 18 years of age or older) who live with you. Name Former/Maiden/Alias Date of Birth Gender Relationship to You SSN SECTION C: Requirements, Acknowledgement, and Signature (License Exempt-Related/Unrelated) REQUIREMENTS I understand and agree to the following requirements to be a CDC Provider: 1. I am at least 18 years of age. 2. Neither I, nor any adult in my household (License Exempt-Related only), have been found responsible for the neglect or abuse of children by Children s Protective Services (CPS) or been charged/convicted of crimes associated with money, abuse, or related to health and safety. 3. I do not have any physical, emotional, or other barriers that would prevent me from giving adequate care and supervision to children in my care. 4. I know how and when to seek help from others, such as how to use the telephone and how to respond to emergency situations that might arise while children are in my care. 5. I have not had any license or registration revoked or suspended by the Bureau of Community and Health Systems (BCHS), the Michigan Department of Licensing and Regulatory Affairs (LARA), or the Michigan Department of Health and Human Services (MDHHS). 6. I have no other jobs or other obligations that conflict or interfere with the hours that I provide child care. 7. I understand that a provider who will be providing care in the child s home must complete a fingerprint-based national background check through the Federal Bureau of Investigation and must submit to health and safety visits. 8. I understand that a provider who is caring for a CDC eligible child must complete Great Start to Quality Orientation training in order to receive CDC payments. If I have not already completed this one-time required training, I should visit www.miregistry.org or call 877-614-7328 as soon as possible to find a Great Start to Quality Orientation training in my area. Revised 03.01.2019 MDE is an equal opportunity employer/program. 4

Child Development and Care (CDC) License Exempt Provider Application ACKNOWLEDGEMENTS I certify that I meet the previous requirements to be a CDC provider, and I understand the following: 1. The terms and conditions of my provider enrollment may be changed without advanced notice. 2. I will not receive CDC payments for any care provided for children before my application date or more than 30 days before I complete the Great Start to Quality Orientation training. 3. All changes in my name, address, household members, or telephone number must be reported within 10 calendar days to the Child Development and Care office at 866-990-3227. Failure to report changes may result in termination of my enrollment. 4. I can only receive CDC payment for care provided in Michigan. 5. I must not care for more than six (6) children at the same time. Children not related to me must be cared for in the child s own home. 6. I must not care for more than two (2) children under 12 months of age at the same time. 7. I must give the parents/substitute parents of the children in my care unlimited access to their children while they are in my care. 8. I must only release a child to the parent/substitute parent or persons authorized by the parent/substitute parent. 9. I must immediately report suspected child abuse or neglect to MDHHS Central Intake at 855-444-3911. 10. As a license exempt provider, I understand that I am not employed by the State of Michigan or the CDC program, and I am not eligible for employee-related benefits, such as Worker's Compensation, healthcare, or Unemployment Insurance. 11. As a license exempt provider receiving payment from the State of Michigan CDC program, I understand that I am either self-employed or employed by the parent. I (or the parent) am responsible for reporting my earnings to Federal, State, and local tax authorities in accordance with IRS rules. For IRS information, visit www.irs.gov. 12. I must use the required CDC Daily Time and Attendance Record, found at www.michigan.gov/childcare, showing the Care Begin and Care End times for each CDC child. The parent/substitute parent must certify that these records are accurate by initialing each day for each child to indicate the entries are correct. I must keep these records for four (4) years. 13. I must provide my CDC Daily Time and Attendance Records, and any other requested information, when asked by the State of Michigan. 14. I must only bill for child care services when a CDC child is physically in my care (except for child absences on a day when the child would normally be in my care). 15. Payment for all CDC eligible children in my care is limited to 2,016 hours in a two-week (biweekly) pay period. 16. I may be prosecuted for fraud if my intentional misrepresentation causes an overpayment. 17. If I am overpaid for any reason, even if I am overpaid in error, I must repay the CDC program. If I am overpaid, the CDC program may collect up to 20% of any future payments, which will be applied to my overpayment balance until the overpayment has been fully repaid. 18. I understand if I violate any of the CDC program rules, I may be removed from the CDC program for six (6) months, twelve (12) months, or a lifetime. By signing this, I am agreeing to all terms on this application and those in the Child Development and Care Handbook found at www.michigan.gov/childcare. I am also indicating that the information I have provided is true and accurate to the best of my knowledge. SIGNATURE: I HAVE READ AND UNDERSTAND ALL PARTS OF THIS FORM. (must be completed by provider) Signature (required) Date of signature Make a copy of the rights and acknowledgements and keep the copy for your records. Revised 03.01.2019 MDE is an equal opportunity employer/program. 5

SECTION D: Consent and Disclosure (License Exempt-Unrelated only) STATE OF MICHIGAN DEPARTMENT OF EDUCATION MICHIGAN CHILD CARE BACKGROUND CHECK CONSENT AND DISCLOSURE Part 1 Individual Rights Part 2 Disclosure Part 3 Applicant Information Part 4 Reporting Requirement Part 5 Consent Part 6 -- Certification The Child Care Background Check Program is used to conduct background checks of license exempt child care providers in Michigan. The system will be used by the Michigan Department of Education (MDE) to receive results for license exempt - unrelated applicants. Applicants must have a background check, including fingerprints. Refusal to submit to this background check will result in not being eligible to receive Child Development and Care (CDC) payments. Part 1 Individual Rights a. I understand that with my written request, I will receive a copy of any records found on any of the registries or databases. b. I understand that if the results of any information found on any registry is not correct, it is up to me to contact the registry to correct it. c. I understand that if the results of the background check are not correct, or if the conviction found in the record is one that was expunged or set aside, I may file a redetermination request with the Department of Licensing and Regulatory Affairs (LARA). Part 2 Disclosure Statements (applicant disclosure) Convictions for certain crimes, and/or being listed on certain registries, will stop you from being enrolled in the CDC program. For more details on the crimes or registries, go to www.michigan.gov/ccbc. List all crimes that you have been convicted of, as well as any findings of child abuse or neglect. (Attach additional sheets if necessary). Offense Date of Conviction/ Finding City State Revised 03.01.2019 MDE is an equal opportunity employer/program. 6

Part 3 Applicant Information required to process a comprehensive background check. You must answer all questions completely and neatly or delays could result. Individual Information Social Security Number - - Date of Birth / / Personal Information (Legal Name) First Name Middle Name Last Name Suffix Place of Birth (State) List All Previous Names Citizenship, Country of Height Hair Color Gender Male Female Weight Eye Color Race Current Address Address City State/Province Zip County Add previous Michigan address as needed Address City State/Province Zip County Do you have more previous Michigan addresses? Yes No Residency Did you live outside of Michigan within the last five years? Yes Previous non-michigan address (use additional paper, if applicable) Date of Residency From To No If Yes, you must complete previous addresses Country City Address State/Province Zip County Do you have more previous non-michigan addresses? Yes No Phone/E-mail address Phone Number Email Revised 03.01.2019 MDE is an equal opportunity employer/program. Driver s License or State Identification Number State issued 7

Part 4 Reporting Requirement I understand that if I am enrolled in the program, I am required to report to CDC within 3 business days after I have been charged or convicted of a crime that is on the crime code list, located at www.michigan.gov/childcare in the Providers section. Part 5 Consent to Conduct Background and Criminal Record Check (applicant consent) To be considered for enrollment in the CDC program: a. I consent to and give permission to MDE through the Department of Licensing and Regulatory Affairs (LARA), to conduct a background check that includes: 1) a review of the licensing database of people with previous disciplinary action in a child care center, group child care home, family child care home, or an adult foster care facility; 2) a search through the national and state sex offender registries; 3) a search through all state criminal registries for any states where I've lived in the past five years; 4) a request that the Michigan State Police (MSP) perform a criminal history check; and 5) a search of the child abuse and neglect registry for Michigan and any states where I've lived for the past five years. b. I understand that refusing the background check or knowingly providing false information in connection with a background check will result in my being found not eligible. c. I understand that MDE will make the final decision as to whether I am enrolled in the CDC program. I also understand that MDE may end the background check or decide to not allow me to enroll in the CDC program at any stage in the process. d. I agree to provide all the information necessary to conduct a background check. Privacy Act Statement: Authority: Acquisition, preservation, and exchange of fingerprints and associated information by the Federal Bureau of Investigation (FBI) is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes, State statues pursuant to Pub. L. 92-544, Presidential Executive Orders, and federal regulations. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application. Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI s Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information /biometrics are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the FBI s Blanket Routine Uses. Routine Uses include, but are not limited to, disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment, contracting, licensing, security clearances, and other suitability determinations; local, state tribal, or federal law enforcement agencies; criminal justice agencies; and agencies responsible for national security or public safety. Revised 03.01.2019 MDE is an equal opportunity employer/program. Continued on Next Page 8

Procedure to Obtain a Change, Correction, or Update of Identification Records: If, after reviewing his/her identification record, the subject thereof believes that it is incorrect or incomplete in any respect and wishes changes, corrections, or updating of the alleged deficiency; he/she should make application directly to the agency which contributed the questioned information. The subject of a record may also direct his/her challenge as to the accuracy or completeness of any entry on his/her record to the FBI, Criminal Justice Information Services (CJIS) Division, ATTN: SCU, Mod. D2, 1000 Custer Hollow Road, Clarksburg, WV 26306. The FBI will then forward the challenge to the agency which submitted the data requesting that agency to verify or correct the challenged entry. Upon the receipt of an official communication directly from the agency which contributed the original information, the FBI CJIS Division will make any changes necessary in accordance with the information supplied by that agency. (28 CFR 16.34). Consent: I understand that my personal information and biometric data being submitted by Live Scan, will be used to search against identification records from both the Michigan State Police (MSP) and the FBI for the purpose listed above. I hereby authorize the release of my personal information for such purposes and release of any records found to the authorized requesting agency listed above. Part 6 - Certification I certify that all of the above statements are correct and complete and that failure to provide correct information may result in being found not eligible. Applicant's Name (Printed) Applicant s Signature Date THIS FORM MUST BE MAINTAINED IN THE PROVIDER FILE Revised 03.01.2019 MDE is an equal opportunity employer/program. 9

STATE OF MICHIGAN DEPARTMENT OF EDUCATION MICHIGAN CHILD CARE BACKGROUND CHECK CONSENT AND DISCLOSURE Part 1 Individual Rights Part 2 Disclosure Part 3 Applicant Information Part 4 Reporting Requirement Part 5 Consent Part 6 -- Certification The Child Care Background Check Program is used to conduct background checks of license exempt child care providers in Michigan. The system will be used by the Michigan Department of Education (MDE) to receive results for license exempt - unrelated applicants. Applicants must have a background check, including fingerprints. Refusal to submit to this background check will result in not being eligible to receive Child Development and Care (CDC) payments. Part 1 Individual Rights a. I understand that with my written request, I will receive a copy of any records found on any of the registries or databases. b. I understand that if the results of any information found on any registry is not correct, it is up to me to contact the registry to correct it. c. I understand that if the results of the background check are not correct, or if the conviction found in the record is one that was expunged or set aside, I may file a redetermination request with the Department of Licensing and Regulatory Affairs (LARA). Part 2 Disclosure Statements (applicant disclosure) Convictions for certain crimes, and/or being listed on certain registries, will stop you from being enrolled in the CDC program. For more details on the crimes or registries, go to www.michigan.gov/ccbc. List all crimes that you have been convicted of, as well as any findings of child abuse or neglect. (Attach additional sheets if necessary). Offense Date of Conviction/ Finding City State Revised 02.2019 MDE is an equal opportunity employer/program. 1

Part 3 Applicant Information required to process a comprehensive background check. You must answer all questions completely and neatly or delays could result. Individual Information Social Security Number - - Date of Birth / / Personal Information (Legal Name) First Name Middle Name Last Name Suffix Place of Birth (State) List All Previous Names Citizenship, Country of Height Hair Color Gender Male Female Weight Eye Color Race Current Address Address City State/Province Zip County Add previous Michigan address as needed Address City State/Province Zip County Do you have more previous Michigan addresses? Yes No Residency Did you live outside of Michigan within the last five years? Yes Previous non-michigan address (use additional paper, if applicable) Date of Residency From To No If Yes, you must complete previous addresses Country City Address State/Province Zip County Do you have more previous non-michigan addresses? Yes No Phone/E-mail address Phone Number Email Revised 02.2019 MDE is an equal opportunity employer/program. Driver s License or State Identification Number State issued 2

Part 4 Reporting Requirement I understand that if I am enrolled in the program, I am required to report to CDC within 3 business days after I have been charged or convicted of a crime that is on the crime code list, located at www.michigan.gov/childcare in the Providers section. Part 5 Consent to Conduct Background and Criminal Record Check (applicant consent) To be considered for enrollment in the CDC program: a. I consent to and give permission to MDE through the Department of Licensing and Regulatory Affairs (LARA), to conduct a background check that includes: 1) a review of the licensing database of people with previous disciplinary action in a child care center, group child care home, family child care home, or an adult foster care facility; 2) a search through the national and state sex offender registries; 3) a search through all state criminal registries for any states where I've lived in the past five years; 4) a request that the Michigan State Police (MSP) perform a criminal history check; and 5) a search of the child abuse and neglect registry for Michigan and any states where I've lived for the past five years. b. I understand that refusing the background check or knowingly providing false information in connection with a background check will result in my being found not eligible. c. I understand that MDE will make the final decision as to whether I am enrolled in the CDC program. I also understand that MDE may end the background check or decide to not allow me to enroll in the CDC program at any stage in the process. d. I agree to provide all the information necessary to conduct a background check. Privacy Act Statement: Authority: Acquisition, preservation, and exchange of fingerprints and associated information by the Federal Bureau of Investigation (FBI) is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes, State statues pursuant to Pub. L. 92-544, Presidential Executive Orders, and federal regulations. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application. Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI s Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information /biometrics are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the FBI s Blanket Routine Uses. Routine Uses include, but are not limited to, disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment, contracting, licensing, security clearances, and other suitability determinations; local, state tribal, or federal law enforcement agencies; criminal justice agencies; and agencies responsible for national security or public safety. Continued on Next Page Revised 02.2019 MDE is an equal opportunity employer/program. 3

Procedure to Obtain a Change, Correction, or Update of Identification Records: If, after reviewing his/her identification record, the subject thereof believes that it is incorrect or incomplete in any respect and wishes changes, corrections, or updating of the alleged deficiency; he/she should make application directly to the agency which contributed the questioned information. The subject of a record may also direct his/her challenge as to the accuracy or completeness of any entry on his/her record to the FBI, Criminal Justice Information Services (CJIS) Division, ATTN: SCU, Mod. D2, 1000 Custer Hollow Road, Clarksburg, WV 26306. The FBI will then forward the challenge to the agency which submitted the data requesting that agency to verify or correct the challenged entry. Upon the receipt of an official communication directly from the agency which contributed the original information, the FBI CJIS Division will make any changes necessary in accordance with the information supplied by that agency. (28 CFR 16.34). Consent: I understand that my personal information and biometric data being submitted by Live Scan, will be used to search against identification records from both the Michigan State Police (MSP) and the FBI for the purpose listed above. I hereby authorize the release of my personal information for such purposes and release of any records found to the authorized requesting agency listed above. Part 6 - Certification I certify that all of the information I have provided is correct and complete and that failure to provide correct information may result in being found not eligible, and I agree to all information contained in this form. Applicant's Name (Printed) Applicant s Signature Date THIS FORM MUST BE MAINTAINED IN THE PROVIDER FILE Revised 02.2019 MDE is an equal opportunity employer/program. 4

Required Documents/Verifications for License Exempt Providers 1. A completed Child Development and Care License Exempt Provider Application. Mail or fax information to Michigan Department of Education, Child Development and Care Program below. Applications are found at www.michigan.gov/childcare 2. Proof of Identity. Acceptable verifications include the following: Current, valid Driver s License. Federal, state, or local government-issued identification card with the same information that is included on a driver s license. U.S. passport. School-issued identification with a photograph. Form I-551, Green Card or Alien Registration Card. 3. Proof of Age. 4. A copy of a valid Social Security card. 5. Proof of residential and/or mailing address. Acceptable verification includes: Current, valid driver s license Other ID which provides name and address. Current mortgage or rent receipt. Current utility bill showing service at the address (includes, but is not limited to water, gas, electric, and cable). Current pay stubs with the provider s name and address. Current homeowner s insurance policy. Note: The name on all verifications must be the same and must match the provider name listed on the application. Please only send copies as information will be retained for the provider files. Information should be mailed or faxed to: Michigan Department of Education Mail: Child Development and Care Program Provider Enrollment P. O. Box 30267 Lansing, MI 48909 Fax: 517-284-7529

Child Development and Care - License Exempt (Formerly Unlicensed) Provider Registration Process Step 1: Application and Orientation Training Step 2: Submit Application Complete the Child Development and Care (CDC) License Exempt Provider Application, located at www.michigan.gov/childcare. If you have not previously completed the one-time Great Start to Quality Orientation training, visit www.miregistry.org or call 1-877-614-7328 to be registered for training. You may complete the application and training processes at the same time. (It is not necessary to do one before the other.) Care provided before the application is submitted and more than 30 days before training was completed is not eligible for payment by CDC. Mail or fax your completed application to CDC, along with proof of your identity, age, residential address, and a copy of your Social Security Card. The name and address on your proofs must match the information on your application. Fax number: 517-284-7529. Address: Michigan Department of Education, Child Development and Care, P.O. Box 30267, Lansing, MI 48909. Note: Failure to provide the required proofs and a valid phone number will result in your application being denied. Step 3: Interview The CDC office will contact you for a mandatory phone interview at the phone number listed on the application. Step 4: Enrollment Process Applicant and household member information will be entered into the Provider Enrollment System. Criminal background checks will be completed on the applicant in the following manner: License Exempt-Related applicants: Background checks will be done on the applicant and all adult household members using Internet Criminal History Access Tool (ICHAT), Public Sex Offender Registry (PSOR), Offender Information Tracking System (OTIS), and the Child Abuse and Neglect Central Registry. License Exempt-Unrelated applicants: Background checks will be done on the applicant using Internet Criminal History Access Tool (ICHAT), Public Sex Offender Registry (PSOR), Offender Information Tracking System (OTIS), and the Child Abuse and Neglect Central Registry. In addition to the checks mentioned above, License Exempt-Unrelated applicants will also need a comprehensive FBI fingerprint check.

Step 5: Eligibility Decision You will receive the Eligibility Decision Notice, which will include your provider ID number. If no criminal history matches were found during your enrollment, the notice will indicate you are approved. If there were criminal history matches found during the enrollment, the notice will indicate you are denied. Step 6: Review of Denial of a License Exempt- Related Provider Application Due to Background Check If your License Exempt provider application is denied due to the criminal background check done using Internet Criminal History Access Tool (ICHAT), Public Sex Offender Registry (PSOR), or Offender Information Tracking System (OTIS), you will be notified by mail of the denial and provided instructions regarding your options to request an Administrative Review of the denial. Step 7: Review of Denial of a License Exempt- Unrelated Provider Application Due to Fingerprint Check If your License Exempt-Unrelated provider application is denied due to the results of the fingerprint check and you believe that the results are in error, you may file a redetermination request with the Department of Licensing and Regulatory Affairs. Note: The fingerprint check only applies to License Exempt-Unrelated providers.

License Exempt Provider Checklist To become eligible for payment as a License Exempt Child Development and Care (CDC) Provider, a provider applicant must do all of the following: 1. Submit an application to Michigan Department of Education (MDE) CDC office. 2. Complete the Great Start to Quality Orientation (GSQO) training. Register for training at www.miregistry.org A Provider ID number is not needed to register and complete this $10 training. Note: A provider may be allowed to back-bill for child care provided up to 30 days before completing GSQO. This checklist is designed as a guide to assist providers with the MDE enrollment process. Steps for Provider Complete the CDC License Exempt Provider Application, located at www.michigan.gov/childcare. Submit the completed application, along with proof of your identity, age, residence, and a copy of your Social Security card, to MDE Child Development and Care (fax number and address are listed on the application). Participate in the mandatory phone interview. The CDC office will contact you for this interview. Because applications are processed in the order they are received, the date and time of your interview call will depend on the number of applications ahead of yours. Tips To ensure you are using the correct application, be sure it says Michigan Department of Education at the top of the application. Include a phone number where you can be reached for the required telephone interview. Include all required proofs listed above. Failure to provide CDC with the required proofs will result in the provider s application being denied. If you have completed the required GSQO training and have not submitted a License Exempt Provider Application to CDC, you should do so immediately to begin the enrollment process. What to Expect After Applying After all verifications have been received and the interview successfully completed, the CDC office will process the application and determine the provider s eligibility. The provider will receive a notice of approval or denial when the determination is made. License Exempt Unrelated providers who will be providing care in the child s home must complete a fingerprintbased national background check through the Federal Bureau of Investigation and must submit to a health and safety visit. At this time, license exempt (unlicensed) providers who have been approved and have completed GSQO can be approved for payment for any CDC eligible children in their care. To initiate this, the Michigan Department of Health and Human Services (MDHHS) must be given a completed and signed Child Development and Care Provider Verification [DHS-4025]. Once the child(ren) is authorized by MDHHS, the provider will receive a Child Care Provider Authorization [DHS- 198], which includes the begin date of child care assistance for each child and the number of child care hours authorized for each pay period. Tips MDHHS has up to 30 calendar days to determine eligibility for a CDC parent applicant. A PIN for the billing system will only be mailed to first time providers. Providers who have been authorized previously and do not remember their PIN will need to request a replacement by calling CDC at 1-866-990-3227. All PINs are mailed in blank envelopes for security purposes. Questions? For resources on how to bill, please visit www.michigan.gov/childcare under the Provider section. For questions about provider enrollment, please contact CDC at 1-866-990-3227, option 1. Questions about a child s eligibility should be directed through the parent to their local MDHHS office.

CHILD DEVELOPMENT AND CARE (CDC) DAILY TIME AND ATTENDANCE RECORD Michigan Department of Education Provider Name Provider ID Number Pay Period Number Page Number Child Information Sunday Monday Tuesday Wednesday Thursday Friday Saturday Date Child Full Name Begin Time : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM End Time : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM Absence Hours Parent Initials Child Full Name Begin Time : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM End Time : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM Absence Hours Parent Initials Child Full Name Begin Time : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM End Time : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM Absence Hours Parent Initials Child Full Name Begin Time : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM End Time : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM : AM/PM Absence Hours Parent Initials I certify the following information: The above billing information is true and accurate to the best of my knowledge based on available information. I know I must keep complete and accurate records for each approved CDC child in care for four years, showing time of arrival and departure for each child on a daily basis. I understand that if benefits are overpaid for any reason, the extra benefits received will have to be repaid. If intentional misrepresentation caused the overpayment, the responsible party, including any adult in the program group or the group s authorized representative or provider of goods or services, may be disqualified from the program and/or prosecuted for fraud. Provider Signature: Date: Confirmation Number: Rev. 10.2018

INSTRUCTIONS: When completing your CDC Daily Time and Attendance Record, you will need to record: Provider Name: Enter your name or the name of your facility. Provider ID Number: Enter the 7-digit ID number (not license number) listed on the DHS-198, Child Development and Care (CDC) Provider Authorization. Pay Period Number: Enter the number of the pay period that corresponds to the billing dates. Use a separate page for each week. Page Number: Enter the page number. Use additional pages if you care for more than four children. Child s Full Name: Enter the full name of each child for whom care has been authorized for the billing period. Place them in alphabetical order by last and first name. Begin and End Times: Enter the time in hours and minutes, indicating if it is AM or PM by circling the appropriate designation. This may be more or less than the number of hours authorized on the DHS-198. Absence Hours: Child absence hours (not to exceed 360 hours per fiscal year- October 1 to September 30) may be billed for any periods in which the child is not in care when he/she would have normally been in attendance. This includes periods when the provider is open for business, as well as when the facility is closed. Child absence hours cannot be billed after the child s last day in attendance. If you do bill child absence hours, you may not enter more hours than the child would have normally been in care that day. In the box for the day that the absence occurred, enter the time in and out that the child would normally have attended. When 10 days of absence hours are billed for a child, and no care hours have been billed, payment will not issue for additional absence hours until care hours are billed. This will prevent the payment of excessive absence hours that do not reflect a child s normal attendance. Parent or Authorized Representative Initials: The parent or authorized representative must initial daily for each child for each day that hours will be billed (care hours or child absence hours) to indicate that the entries are correct. Provider s Signature and Date: The person authorized to complete the billings must sign and date the form. Confirmation Number: Enter the confirmation number found in the upper right corner of the DHS-105, Child Development and Care Billing/Attendance Invoice. Information: At the end of each pay period, providers must bill for child care hours by using I-Billing at: www.michigan.gov/childcare. You will need your Provider ID number, and PIN. For questions about billing, refer to the Child Development and Care Handbook. If you still need help call the CDC Office at 1-866-990-3227. Please note: Parents are responsible for child care expenses that are not paid by the department, including expenses incurred while a parent or provider s eligibility is being determined.

CDC DAILY TIME AND ATTENDANCE RECORD Michigan Department of Education CDC 2018 PAYMENT SCHEDULE The CDC Payment Schedule gives you the Pay Period Dates, Pay Period Numbers, Billing Deadline Dates, and the estimated Check/EFT Date. Pay Period Begin Date Pay Period End Date Pay Period Number Billing Deadline Date Check/EFT Issue Date 12/24/17 1/6/18 801 1/11/18 ** 1/19/18 1/7/18 1/20/18 802 1/25/18 2/1/18 1/21/18 2/3/18 803 2/8/18 2/15/18 2/4/18 2/17/18 804 2/22/18 3/1/18 2/18/18 3/3/18 805 3/8/18 3/15/18 3/4/18 3/17/18 806 3/22/18 3/29/18 3/18/18 3/31/18 807 4/5/18 4/12/18 4/1/18 4/14/18 808 4/19/18 4/26/18 4/15/18 4/28/18 809 5/3/18 5/10/18 4/29/18 5/12/18 810 5/17/18 5/24/18 5/13/18 5/26/18 811 5/31/18 6/7/18 5/27/18 6/9/18 812 6/14/18 6/21/18 6/10/18 6/23/18 813 6/28/18 ** 7/6/18 6/24/18 7/7/18 814 7/12/18 7/19/18 7/8/18 7/21/18 815 7/26/18 8/2/18 7/22/18 8/4/18 816 8/9/18 8/16/18 8/5/18 8/18/18 817 8/23/18 8/30/18 8/19/18 9/1/18 818 9/6/18 9/13/18 9/2/18 9/15/18 819 9/20/18 9/27/18 9/16/18 9/29/18 820 10/4/18 10/11/18 9/30/18 10/13/18 821 10/18/18 10/25/18 10/14/18 10/27/18 822 11/1/18 ** 11/9/18 10/28/18 11/10/18 823 * 11/14/18 11/21/18 11/11/18 11/24/18 824 11/29/18 12/6/18 11/25/18 12/8/18 825 12/13/18 12/20/18 12/9/18 12/22/18 826 * 12/26/18 ** 1/4/19 Billing deadlines on days before holidays are at 4:00pm on the indicated date (*). Otherwise, they are at the end of the day (midnight). Please plan for delays in payments (**) during holiday periods when State offices and post offices are closed.

Case Name: Case Number: Date: MDHHS Office: Specialist: Phone: Fax: Specialist ID: CHILD DEVELOPMENT AND CARE (CDC) PROVIDER VERIFICATION PURPOSE: You have received this form because you have applied for assistance with child care expenses through the Child Development and Care (CDC) program or have changed your CDC provider. You must complete and send this form to your MDHHS specialist via mail, fax or by using www.michigan.gov/mibridges. Your provider will not receive payment until you complete this form, receive your approval notice and the provider bills child care hours. INSTRUCTIONS: Work with your chosen provider to complete all the information included on Page 1 and Page 2 of this form. Both you and your provider must read the agreement and sign and date Page 2. Return the form to your MDHHS specialist. You and your provider will receive a notice from the CDC program when your form is processed. Your CDC may remain approved without a provider, however, the care begin date will not go back more than 60 days from when this form is received. SECTION 1: PROVIDER INFORMATION (To be completed by the provider) Provider or Child Care Center Director Name Child Care Center Name Provider CDC ID # Address (Number and Street) City State Zip Code MI County Telephone Number Email - - Do you receive any other payments (such as from an employer, child support, or other assistance program) for caring for the children listed in Section 2? NO YES If YES, for what children (list children)? If YES, whom do you receive payment from? Where do you usually care for the children listed in Section 2? (Check one) Note: If you are a license exempt provider who is not related to the children in Section 2, you must provide care in the children s home. Child Care Center Group Child Care Home Family Child Care Home Home Where The Child Lives My Home SECTION 2: CHILD INFORMATION (To be completed by the provider): (Please list all children in the family in your care. Attach a list of additional children to this form if needed.) Child s Name Date of Birth Date Care Began Is the child related to you? 1. NO YES 2. NO YES 3. NO YES 4. NO YES The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability. AUTHORITY: Public Act 280 of 1939. COMPLETION: Mandatory. CONSEQUENCE FOR NONCOMPLETION: Child care subsidy payments will not be authorized. If YES, how are you related? DHS-4025 (Rev. 7-18) Previous edition obsolete. 1 For additional assistance, contact your MDHHS specialist.

Case Name Case Number Specialist SECTION 3: PARENT/SUBSTITUTE PARENT AGREEMENT (To be completed by the parent) By signing, you agree to the following: 1. I am responsible for any child care expenses not paid by the Department for the time my child is in care. 2. I understand that if I choose a license exempt provider: a. CDC payments will be issued to me and I am responsible for paying my provider. b. I am responsible for reporting child care payments to the IRS and issuing my provider a Form W-2 or Form 1099 MISC, if appropriate. 3. I certify that my child or children are or will be in care with this provider as of the date care began listed in Section 2. 4. I understand that my child care agreement is between myself and my provider. 5. I understand that the Department may request information from me in order to verify my provider s billing information. 6. I understand and agree that if an overpayment is made to my provider for any reason, my provider must repay the extra payments. To help repay the money, the Department may reduce any future payments to my provider by up to 20%. 7. I understand that I may be prosecuted for perjury or fraud if I intentionally leave out or give any false information that causes me to receive CDC benefits that I am either not qualified for, or are greater than what I should receive. 8. I understand if I violate any of the program rules, I may be disqualified from the program for six (6) months, 12 months, or a lifetime. Parent/Substitute Parent Signature Date SECTION 4: PROVIDER AGREEMENT (To be completed by the provider) By signing, you agree to the following: 1. I understand if I am a license exempt provider: a. I must apply to be a CDC provider by completing the CDC License Exempt Provider Application. The application can be found at www.michigan.gov/childcare b. I will not receive CDC payment for any care I provide more than 30 calendar days before I complete the Great Start to Quality Orientation training. More information on the training can be found at www.greatstarttoquality.org. c. CDC payments will be issued to the parent of the child or children in care. The parent is responsible for paying me, reporting my wages to the IRS, and issuing me a Form W-2 or Form 1099 MISC, when appropriate. d. I will use the CDC Daily Time and Attendance form found at http://www.michigan.gov/childcare. 2. I understand that I am not employed by the State of Michigan or the CDC Program, and that I will not receive unemployment insurance. 3. I will maintain time and attendance records for each child in my care. Each child s parent/substitute parent must sign the records each day they are in my care. I will retain these records for four (4) years. 4. Parents of the children in care will have unlimited access to their children while in my care. 5. If an audit or investigation finds that I do not keep accurate time and attendance records, I may have to return CDC payments to the Department. 6. If I am overpaid for any reason, I must repay the Department, even if I am overpaid in error. If I am overpaid, the Department may hold up to 20% of any future payments. 7. I am responsible for what happens in the CDC I-Billing system by anyone using my PIN. 8. I will immediately contact the CDC office at 866-990-3227 to request a PIN reset if someone has accessed my PIN without my permission. 9. I will not bill for hours when the child is in school, to hold a spot for a child, or if the child is not expected to return to my care. 10. I understand that I may be prosecuted for perjury or fraud if I intentionally leave out or give false information that causes the parent/substitute parent to receive CDC benefits they are either not qualified for, or are greater than what they should receive. 11. I understand if I violate any of the program rules, I may be disqualified from the program for six (6) months, 12 months, or a lifetime. Provider Signature Date For more information and requirements, see the CDC program handbook at http://www.michigan.gov/childcare DHS-4025 (Rev. 7-18) Previous edition obsolete. 2 For additional assistance, contact your MDHHS specialist.

support@miregistry.org 833.386.9238 www.miregistry.org What is MiRegistry? MiRegistry is a statewide data system for professionals, trainers and organizations to verify and track employment, training and educational accomplishments. How does MiRegistry benefit me? INDIVIDUALS TRAINERS ORGANIZATIONS Early Childhood and Out of School Time Professionals Professional Development Facilitators Training Sponsor Agencies and Employers of the Early Childhood and Out of School Time Workforce Track employment, education & training history. Track course curriculum and training events as a statewide approved trainer. Promote training events on the MiRegistry Statewide Training Calendar. Promote training events on the MiRegistry Statewide Training Calendar. Access verified staff qualifications for meeting Licensing and Great Start to Quality requirements. Utilize online registration, attendance verification, and evaluation for training events. Track staff completion of licensing and accreditation training requirements. Plan professional development with access to easy-to-read individual training summaries. Find quality professional growth opportunities on the MiRegistry Statewide Training Calendar. Materials for the Michigan Registry were developed in part with federal funds awarded to the Michigan Department of Education.