Quick Links:

Licensed/Registered Provider Forms
Legally-Exempt Provider Forms
Local Department of Social Services Forms

Child Care Forms

Licensed/Registered Provider

LDSS-3370 Statewide Central Register Database Check
(LDSS-3370 Word) (LDSS-3370 PDF)
B2H Survey Card
(B2H PDF 62 KB)
LDSS-4434-1 Medical Statement
(LDSS-4434-1 Word 109 KB) (LDSS-4434-1 PDF 76 KB)
LDSS-4434-4 Household Member Medical Statement
(LDSS-4434-4 Word 121 KB) (LDSS-4434-4 PDF 46 KB)
LDSS-4436 Incident Report for Child Day Care
(LDSS-4436 Word 53 KB) (LDSS-4436 PDF 40 KB)
LDSS-4438 Emergency Evacuation Plan for Child Day Care
(LDSS-4438 Word 57 KB) (LDSS-4438 PDF 46 KB)
LDSS-4439 Record of Fire Drills for Child Day Care
(LDSS-4439 Word 90 KB) (LDSS-4439 PDF 66 KB)
LDSS-4440 Schedule of Program Activities for Child Day Care
(LDSS-4440 Word 86 KB) (LDSS-4440 PDF 55 KB)
LDSS-4441 Discipline Policy Statement for Child Day Care
(LDSS-4441 Word 44 KB) (LDSS-4441 PDF 49 KB)
LDSS-4442 Menu Planning for Child Day Care
(LDSS-4442 Word 54 KB) (LDSS-4442 PDF 45 KB)
LDSS-4443 Daily Attendance Record Child Day Care
(LDSS-4443 Word 398 KB) (LDSS-4443 PDF 18 KB)
LDSS-4553 Child Day Care on Site Inspection Report
(LDSS-4553 Word 58 KB)
OCFS-4879 Day Care Program Training Tracking Chart
(OCFS-4879 Word 233 KB) (OCFS-4879 PDF 18 KB)
OCFS-4879S HOJA PARA REGISTRAR LA CAPACITACION DEL PERSONAL EN UN PROGRAMA DE CUIDADO DIURNO
(OCFS-4879S Word 202 KB) (OCFS-4879S PDF 18 KB)
OCFS-4880 Individual Training Tracking Form for Child Care Personnel
(OCFS-4880 Word 221 KB) (OCFS-4880 PDF 17 KB)
OCFS-4880S HOJA PARA REGISTRAR LA CAPACITACION INDIVIDUAL EN UN PROGRAMA DE CUIDADO DIURNO
(OCFS-4880S Word 208 KB) (OCFS-4880S PDF 17 KB)
OCFS-4890 Report of Death of Child Care
(OCFS-4890 Word 87 KB) (OCFS-4890 PDF 14 KB)
OCFS-4926 Fuel Burning System Inspection
(OCFS-4926 Word 118 KB)
OCFS-4930 Request for NYS Fingerprinting Services Info Form
(OCFS-4930 Word 74 KB) (OCFS-4930 PDF 21 KB)
OCFS-4930-1 Guidelines for Fingerprinting
(OCFS-4930-1 Word 35 KB)
OCFS-4930-1S Guia para Obtener Impresiones Digitales
(OCFS-4930-1S Word 34 KB)
OCFS-4930S Solicitud de Servicios de Impresiones Digitales
(OCFS-4930S Word 70 KB)
OCFS-4932 FAMILY AND GROUP FAMILY DAY CARE PROVIDER REQUEST TO REMOVE STREET ADDRESS AND MAP FROM THE OFFICE OF CHILDREN AND FAMILY SERVICES WEBSITE
(OCFS-4932 Word 49 KB)
OCFS-4932S SOLICITUD PARA RETIRAR DEL PORTAL DE LA AGENCIA DIRECCION Y EL MAPA ASOCIADO CON LA DIRECCION DE UN HOGAR DE CUIDADO DIURNO EN FAMILIA O DE UN GRUPO EN FAMILIA
(OCFS-4932S Word 55 KB)
OCFS-4939 Provider Notification of Licensing or Registration to Fire and Police or Sheriff Departments
(OCFS-4939 Word 74 KB) (OCFS-4939 PDF 14 KB)
OCFS-4939S Notificacion del Proveedor(a) de Cuidado Infantil a los Departamentos de Bomberos y de la Policia sobre su Licencia o Registro
(OCFS-4939S Word 71 KB)
OCFS-LDSS-0792 Day Care Registration
(OCFS-LDSS-0792 Word 79 KB) (OCFS-LDSS-0792 PDF 57 KB)
OCFS-LDSS-4433 Medical Statement of Child in Childcare
(OCFS-LDSS-4433 Word 163 KB) (OCFS-LDSS-4433 PDF 40 KB)
OCFS-LDSS-4838 DCC-Monthly Fire-Safety Inspection for DCC Director or Designee
(OCFS-LDSS-4838 Word 454 KB) (OCFS-LDSS-4838 PDF 227 KB)
OCFS-LDSS-4887 Request for Waiver
(OCFS-LDSS-4887 Word 46 KB) (OCFS-LDSS-4887 PDF 13 KB)
OCFS-LDSS-7019 Illness Injury and Indicators of Abuse Log
(OCFS-LDSS-7019 Word 238 KB) (OCFS-LDSS-7019 PDF 29 KB)
OCFS-LDSS-7019S Registro de Enfermedades, Lesiones e Indicadores de Abuso
(OCFS-LDSS-7019S Word 234 KB) (OCFS-LDSS-7019S PDF 33 KB)
OCFS-LDSS-7020 Health Care Plan - Day Care Center
(OCFS-LDSS-7020 Word 616 KB)
OCFS-LDSS-7020S Plan de Atencion Medica - Centro de Cuidado Infantil - Guaderia Infantil
(OCFS-LDSS-7020S Word 722 KB)
OCFS-LDSS-7021 Health Care Plan - Family Day Care Center - Group Family Day Care Center - Small Day Care Centers
(OCFS-LDSS-7021 Word 602 KB)
OCFS-LDSS-7021S Plan de Atencion Medica - Hogar de Cuidado Diurno en Familia - Hogar de Cuidado Diurno de un Grupo en Familia - Centro Pequeno de Cuidado Infantil
(OCFS-LDSS-7021S Word 675 KB)
OCFS-LDSS-7022 Health Care Plan - School Age Child Care
(OCFS-LDSS-7022 Word 574 KB)
OCFS-LDSS-7024 Evaluation of my Most Recent Licensing-Registration Experience
(OCFS-LDSS-7024 Word 68 KB) (OCFS-LDSS-7024 PDF 13 KB)
OCFS-LDSS-7035 Assistant Information-Group Family Day Care
(OCFS-LDSS-7035 Word 44 KB) (OCFS-LDSS-7035 PDF 22 KB)
OCFS-LDSS-7036 Assistant Qualifications
(OCFS-LDSS-7036 Word 70 KB) (OCFS-LDSS-7036 PDF 36 KB)
OCFS-LDSS-7037 Assistant References
(OCFS-LDSS-7037 Word 68 KB) (OCFS-LDSS-7037 PDF 23 KB)
OCFS-LDSS-7038 Assistant Criminal History Review
(OCFS-LDSS-7038 Word 62 KB) (OCFS-LDSS-7038 PDF 34 KB)
OCFS-LDSS-7039 Assistant Medical Statement
(OCFS-LDSS-7039 Word 59 KB) (OCFS-LDSS-7039 PDF 23 KB)
OCFS-LDSS-7040 Environmental Hazards Guidance Sheet
(OCFS-LDSS-7040 Word 85 KB) (OCFS-LDSS-7040 PDF 99 KB)
OCFS-LDSS-7041 Directions for Completing the Environmental Hazards Statement
(OCFS-LDSS-7041 Word 50 KB) (OCFS-LDSS-7041 PDF 80 KB)
OCFS-LDSS-7042 Environmental Hazard Information Form Parts I and II
(OCFS-LDSS-7042 Word 71 KB) (OCFS-LDSS-7042 PDF 127 KB)
OCFS-LDSS-7043 Plan of Study Commitment for Head of Group for Preschoolers Infants and Toddlers
(OCFS-LDSS-7043 Word 51 KB) (OCFS-LDSS-7043 PDF 28 KB)
OCFS-LDSS-7044 Plan of Study Commitment for Director of Day Care Center
(OCFS-LDSS-7044 Word 60 KB) (OCFS-LDSS-7044 PDF 33 KB)

We appreciate your interest in learning more about the application process to become a child day care provider. The application forms you can download from this site are sample forms only. Each type of child day care requires slightly different forms and information. Reviewing the sample forms at this website prior to requesting an "official" application package will assist you in determining which type of child day care you might be interested in pursuing.

You may request an official application package, which will be specifically tailored to your needs and include the identification number required for processing, by going to http://opal.gorr.state.ny.us

Day Care Center Application Package - SAMPLE
( PDF Day Care Center Application Package - SAMPLE 911 KB)
Day Care Center Renewal Package - SAMPLE
( PDF Day Care Center Renewal Package - SAMPLE 225 KB)
Family Day Care Application Package - SAMPLE
( PDF Family Day Care Application Package - SAMPLE 750 KB)
Family Day Care Renewal Package - SAMPLE
( PDF Family Day Care Renewal Package - SAMPLE 533 KB)
Group Family Day Care Application Package - SAMPLE
( PDF Group Family Day Care Application Package - SAMPLE 888 KB)
Group Family Day Care Renewal Package - SAMPLE
( PDF Group Family Day Care Renewal Package - SAMPLE 595 KB)
School-Age Child Care Application Package - SAMPLE
( PDF School-Age Child Care Application Package - SAMPLE 786 KB)
School-Age Child Care Renewal Package - SAMPLE
( PDF School-Age Child Care Renewal Package - SAMPLE 325 KB)
Small Day Care Center Application Package - SAMPLE
( PDF Small Day Care Center Application Package - SAMPLE 719 KB)

Legally-Exempt Provider

Autism Spectrum Disorders
(Autism PDF 62 KB) (Autism PDF 54 KB)
OCFS-7026 Enrollment Information Packet for Legally-Exempt Providers
(OCFS-7026 Word 278 KB) (OCFS-7026 PDF 333 KB)
OCFS-7026-S Paquete de Informacion Sobre la Inscripcion para Proveedores Legalmente Exentos
(OCFS-7026-S Word 369 KB) (OCFS-7026-S PDF 347 KB)
OCFS-LDSS-4699 Enrollment Form for Provider of Legally-Exempt Family Child Care and Legally-Exempt In-Home Child Care
(OCFS-LDSS-4699 Word 622 KB) (OCFS-LDSS-4699 PDF 126 KB)
OCFS-LDSS-4699--S Formulario de Inscripcion para Proveedor(a) de Servicios de Cuidado Infantil en Familia Legalmente Exento y de Cuidado Infantil a Domicilio
(OCFS-LDSS-4699--S Word 624 KB) (OCFS-LDSS-4699--S PDF 421 KB)
OCFS-LDSS-4699-1 Employment of Minors Form
(OCFS-LDSS-4699-1 Word 36 KB) (OCFS-LDSS-4699-1 PDF 10 KB)
OCFS-LDSS-4699-1-S Formulario de Empleo para Menores de Edad
(OCFS-LDSS-4699-1-S Word 37 KB) (OCFS-LDSS-4699-1-S PDF 31 KB)
OCFS-LDSS-4699-1A Employment of Minors Information
(OCFS-LDSS-4699-1A Word 41 KB) (OCFS-LDSS-4699-1A PDF 17 KB)
OCFS-LDSS-4699-2 Legally-Exempt In-Home Child Care Provider Agreement Form
(OCFS-LDSS-4699-2 Word 43 KB) (OCFS-LDSS-4699-2 PDF 15 KB)
OCFS-LDSS-4699-2-S Acuerdo del Proveedor(a) de Cuidado Infantil en Familia Legalmente Exento
(OCFS-LDSS-4699-2-S Word 43 KB) (OCFS-LDSS-4699-2-S PDF 23 KB)
OCFS-LDSS-4699-2A Parental Responsibilities When Employing a Legally-Exempt In-Home Child Care Provider
(OCFS-LDSS-4699-2A Word 32 KB) (OCFS-LDSS-4699-2A PDF 16 KB)
OCFS-LDSS-4699-3 Legally-Exempt Provider Training Record Form
(OCFS-LDSS-4699-3 Word 50 KB) (OCFS-LDSS-4699-3 PDF 21 KB)
OCFS-LDSS-4699-3-S Registro de Entrenamiento para Proveedores de Cuidado Infantil Legalmente Exento
(OCFS-LDSS-4699-3-S Word 48 KB) (OCFS-LDSS-4699-3-S PDF 44 KB)
OCFS-LDSS-4699-4 Parental Acknowledgment of Criminal History of the Child Care Provider Employee or Volunteer Form
(OCFS-LDSS-4699-4 Word 38 KB) (OCFS-LDSS-4699-4 PDF 12 KB)
OCFS-LDSS-4699-4S Reconocimiento Del Padre-Madre
(OCFS-LDSS-4699-4S Word 36 KB) (OCFS-LDSS-4699-4S PDF 10 KB)
OCFS-LDSS-4700 Enrollment Form for Provider of Legally-Exempt Group Child Care
(OCFS-LDSS-4700 Word 413 KB) (OCFS-LDSS-4700 PDF 117 KB)
OCFS-LDSS-4700S Formulario de Inscripcion para Proveedor de Cuidado Infantil en Grupo Legalmente Exento
(OCFS-LDSS-4700S Word 480 KB) (OCFS-LDSS-4700S PDF 299 KB)
OCFS-LDSS-7000 Health Care Plan for The Administration of Medication
(OCFS-LDSS-7000 Word 314 KB) (OCFS-LDSS-7000 PDF 106 KB)
OCFS-LDSS-7001 Instructions for Completing the Health Care Plan for the Administration of Medication for Legally-Exempt Provider
(OCFS-LDSS-7001 Word 106 KB) (OCFS-LDSS-7001 PDF 109 KB)
OCFS-LDSS-7001S Instrucciones para Completar el Plan de Salud para la Administracion de Medicamentos del Proveedor Legalmente Exento
(OCFS-LDSS-7001S Word 102 KB) (OCFS-LDSS-7001S PDF 123 KB)
OCFS-LDSS-7002 Written Medication Consent Form
(OCFS-LDSS-7002 Word 146 KB) (OCFS-LDSS-7002 PDF 36 KB)
OCFS-LDSS-7003 Verbal Medication Consent Form and Log of Administration
(OCFS-LDSS-7003 Word 146 KB) (OCFS-LDSS-7003 PDF 73 KB)
OCFS-LDSS-7004 Log of Medication Administration
(OCFS-LDSS-7004 Word 208 KB) (OCFS-LDSS-7004 PDF 36 KB)
OCFS-LDSS-7005 Medication Error Report Form
(OCFS-LDSS-7005 Word 115 KB) (OCFS-LDSS-7005 PDF 30 KB)
OCFS-LDSS-7005S Formulario de Informe de Error de Medicacion
(OCFS-LDSS-7005S Word 116 KB) (OCFS-LDSS-7005S PDF 25 KB)
OCFS-LDSS-7006 Individual Health Care Plan for a Child with Special Health Care Needs
(OCFS-LDSS-7006 Word 83 KB) (OCFS-LDSS-7006 PDF 29 KB)
OCFS-LDSS-7006S Plan Individual de Cuidado de la Salud para un Nino(a) con Necesidades Especiales de Cuidado de la Salud
(OCFS-LDSS-7006S Word 83 KB) (OCFS-LDSS-7006S PDF 32 KB)
OCFS-LDSS-7007 Obtaining Authorization to Administer Medication to Subsidized Children in Legally Exempt Care
(OCFS-LDSS-7007 Word 66 KB) (OCFS-LDSS-7007 PDF 58 KB)
OCFS-LDSS-7008 Administration of Medication by Legally-Exempt Child Care Provider
(OCFS-LDSS-7008 Word 47 KB) (OCFS-LDSS-7008 PDF 44 KB)
OCFS-LDSS-7008S Administracion de Medicamentos por el Proveedor de Cuidado Infantil Legalmente Exento
(OCFS-LDSS-7008S Word 51 KB) (OCFS-LDSS-7008S PDF 72 KB)
OCFS-LDSS-7028-1 Home Inspection Report for Legally Exempt Family Child Care Provider
(OCFS-LDSS-7028-1 Word 462 KB) (OCFS-LDSS-7028-1 PDF 79 KB)
OCFS-LDSS-7028-2 Corrective Action Plan for Legally Exempt Child Care Provider
(OCFS-LDSS-7028-2 Word 96 KB) (OCFS-LDSS-7028-2 PDF 23 KB)
OCFS-LDSS-7028-3 Attachment to the Home Inspection Report for Legally Exempt Family Child Care Provider
(OCFS-LDSS-7028-3 Word 114 KB) (OCFS-LDSS-7028-3 PDF 35 KB)

Local Department of Social Services

Autism Spectrum Disorders
(Autism PDF 62 KB) (Autism PDF 54 KB)
OCFS-LDSS-4433 Medical Statement of Child in Childcare
(OCFS-LDSS-4433 Word 163 KB) (OCFS-LDSS-4433 PDF 40 KB)
OCFS-LDSS-4779 Approval of Your Application for Child Care Benefits
(OCFS-LDSS-4779 Word 85 KB)
OCFS-LDSS-4779S APROBACION DE SU SOLICITUD PARA BENEFICIOS DE CUIDADO DE NINOS
(OCFS-LDSS-4779S Word 86 KB)
OCFS-LDSS-4780 DENIAL OF YOUR APPLICATION FOR CHILD CARE BENEFITS
(OCFS-LDSS-4780 Word 67 KB)
OCFS-LDSS-4780S DENEGACION DE SU SOLICITUD PARA BENEFICIOS DE CUIDADO DE NINOS
(OCFS-LDSS-4780S Word 69 KB)
OCFS-LDSS-4781 NOTICE OF INTENT TO CHANGE CHILD CARE BENEFITS
(OCFS-LDSS-4781 Word 86 KB)
OCFS-LDSS-4781S NOTIFICACION SOBRE EL INTENTO DE CAMBIAR LOS BENEFICIOS DE CUIDADO DE NINOS
(OCFS-LDSS-4781S Word 78 KB)
OCFS-LDSS-4782 NOTICE OF INTENT TO DISCONTINUE CHILD CARE BENEFITS
(OCFS-LDSS-4782 Word 63 KB)
OCFS-LDSS-4782S NOTIFICACION SOBRE EL INTENTO DE DISCONTINUAR BENEFICIOS DE CUIDADO DE NINOS
(OCFS-LDSS-4782S Word 66 KB)
OCFS-LDSS-7009 Notice of Child Care Assistance Overpayment and Repayment Requirements
(OCFS-LDSS-7009 Word 88 KB) (OCFS-LDSS-7009 PDF 42 KB)
OCFS-LDSS-7009S Notificacion de Sobrepago de Asistencia Para Cuidado Infantil Y Requisitos de Devolucion
(OCFS-LDSS-7009S Word 106 KB)
OCFS-LDSS-7010 Notice of Fraud Determination Disqualification for Child Care Benefits and Repayment Plan
(OCFS-LDSS-7010 Word 102 KB) (OCFS-LDSS-7010 PDF 38 KB)
OCFS-LDSS-7010S Notificacion de Determinacion de Fraude Descalificacion Para Recibir Beneficios de Cuidado Infantil Y Plan de Devolucion de Pagos
(OCFS-LDSS-7010S Word 125 KB)

Order Hard Copies of Forms

To order hard copies of available forms developed by the New York State Office of Children and Family Services (OCFS), complete the "Request for Forms and Publications" form (OCFS-4627) Microsoft Word - OCFS-4627 / Adobe PDF - OCFS-4627 and mail your request to:

OCFS Resource Distribution Center
11 Fourth Ave
Rensselaer, NY 12144-2629
OR
Call the Forms Hotline: 518-473-0971

New York State

Office of Children & Family Services

Download Forms