N.H. Code Admin. R. He-C 6910.09 - Verification Requirements
(a) The name of
each member of the assistance group shall be verified by one or more of the
following documents:
(1) The individual's
birth certificate;
(2) The
individual's marriage certificate;
(3) The individual's divorce decree, if the
name to be used subsequent to a divorce is changed;
(4) The individual's driver's license or
other identification which contains a picture of the individual; or
(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.
(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) The child's birth certificate;
(2) The child's baptismal certificate; or
(3) The child's US
passport.
(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) The child's
certificate of citizenship or naturalization; or
(2) The following US Citizenship and
Immigration Services (USCIS) forms or documentation:
a. USCIS Form I-551, Permanent Resident card;
b. USCIS Form I-327, Re-entry
Permit;
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;
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
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.
(d) The relationship of any adult in the
assistance group to the child(ren) in the assistance group shall be verified by
one or more of the following:
(1) The child's
birth record containing the name(s) of his or her parent(s);
(2) The adult's birth record;
(3) A marriage certificate containing the
names of the parties who were married, including any maiden or previous names
used;
(4) Any additional birth or
marriage records necessary to show the relationship of the child(ren) to the
adult(s) in the assistance group;
(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) For a
caretaker relative, one or more of the following documents:
a. A court order giving the caretaker
relative the duty of care, custody, and supervision of the child;
b. A document showing power of attorney for
the child(ren) by the caretaker relative with whom the child(ren) lives;
or
c. A statement from the child's
parent(s) that the caretaker relative is the individual who shall provide care
and supervision for the child on his or her behalf.
(e) To verify a current address,
any of the following verifications which show the address of the family shall
be acceptable:
(1) Rental receipts;
(2) If the home is owned, the deed or
mortgage receipts;
(3) Utility or
telephone bills; or
(4) A statement
from the current landlord.
(f) Self-attestation shall be an acceptable
form of verification for children of migrant workers who qualify as homeless
because they are living in circumstances described in
He-C
6910.03(ag).
(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) For self-employment, a parent's current
profit and loss statement or the entire IRS tax filing from the previous year,
as described in He-C
6910.06(d);
(2) Any contributions of monies to the
assistance group from any source, verified by a statement from the contributor
which indicates the amount, frequency, and expected end date of the
contribution;
(3) For earned income
that fluctuates month to month according to
He-C
6910.06(g)(1), a pay stub or a
written statement from the employer stating the monthly amount
earned;
(4) For unearned income
that fluctuates according to
He-C
6910.06(g)(2), a pay stub, a written
statement from the contributor, physical documentation, or a collateral
contract;
(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 or a statement from the employer; or
(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.
(h) The applicant shall
attest that the assistance group's resources, including both personal and real
property, do not exceed $1,000,000.00 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 $1,000,000.00.
(i) To establish a link between the child and
the child care provider, the parent and the child care provider shall complete
and submit to the department Form 1863 "Child Care Provider Verification," (May
2020) with the understanding that:
"A license is required when care is given in a private home for more than 3 children, unrelated to the provider at any given time, in addition to my own children;
I cannot be reimbursed for child care scholarship if I reside in the same home as the child that I am caring for and/or if the child has a biological, step, or adoptive relationship to me; and
The department may release child care information to the above-named provider by the Department of Health and Human Services."
(j) The following verification
requirements shall apply for a child experiencing a disability or significant
special needs requiring additional funds for accommodations or classroom
adaption in the child care setting:
(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 Needs," (May 2020), 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 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";
(2) The
child care provider shall complete section I of Form 2690, "Verification for a
Child Experiencing a Disability or Significant Special Needs" (May 2020),
including signing and dating the form, certifying the following:
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
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) A licensed professional shall complete
section II of Form 2690, "Verification for a Child Experiencing a Disability or
Significant Special Needs," (May 2020), including signing and dating the form,
certifying that one of the following, is applicable:
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
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."
(k) When a parent in a
2-parent household claims that he or she has a disability, acceptable
verification shall be a signed and dated statement from an attending physician,
physician assistant, advance practice registered nurse, or licensed mental
health professional indicating:
(1) The
medical condition, disease, or disability of the adult;
(2) The expected duration of the condition,
disease, or disability; and
(3)
That the adult is unable to work and to care for and supervise his or her
child(ren) because of the condition, disease, or disability.
(l) For those parents who are NHEP
participants but who are in an approved training or educational program,
including any internet training or education programs, the acceptable
verification shall be a signed and dated statement from the school or training
organization indicating:
(1) The parent is
enrolled in the program;
(2) The
duration of the program;
(3) The
class schedule, including hours of class attendance; and
(4) The program shall lead to a degree,
license, or certificate at the associate's level or less in a specific field of
employment.
(m) For
parents who are not receiving TANF financial assistance, but who are in an
approved training or educational program, including any internet training, or
education program the acceptable verification shall be a signed and dated
statement from the school or training organization indicating:
(1) The parent is enrolled in the program;
(2) The program shall lead to a
degree, license or certificate at the associate's level or less in a specific
field of employment;
(3) The
duration of the program; and
(4)
The class schedule, including hours of class attendance.
(n) For the parents receiving TANF financial
assistance and not participating in the NHEP work program, acceptable
verification of the training program or course of study, including any internet
training or education program, shall be a signed and dated statement from the
school or training organization indicating:
(1) The requirements in (m)(1), (3) and (4)
above; and
(2) That the program
shall lead to a degree or certificate at the associate or bachelor's level or
less in a specific field of employment.
(o) When a parent works at least 4 hours on a
night shift 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,
the parent's customer, stating the hours of the shift that the individual works
each week.
(p) If at
redetermination a parent is experiencing one of the circumstances in
He-C
6910.10(o), the following
verification shall be required:
(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 or seasonal break in
employment; or
(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.
(q) When a parent is participating in a job
search at initial application or at redetermination, acceptable verification
shall be:
(1) Proof of receipt of
unemployment compensation benefits;
(2) A personal summary page from the NH
department of employment security's job match; or
(3) The verifications described in
He-W
637.03(g).
(r) When a parent has a permanent job loss
acceptable verification shall be a signed and dated:
(1) Notice of termination from the employer;
and
(2) Other verification from the
employer that the person is no longer employed.
(s) When a parent applying for expedited
child care scholarship is homeless as defined in the McKinney-Vento Homeless
Assistance Act, section 725(2) of
42 USC
11434a(2) (2011), acceptable
verification shall be a self-declaration from the parent that the family is
homeless.
(t) When a parent is
homeless and in an employment related activity and is seeking housing in the
same week, acceptable verification shall be a self-declaration stating that the
parent is homeless and seeking housing while in an employment related activity.
(u) For individuals who are
providing care as a license-exempt child care provider in the child's home but
whose employment is based on the condition described in
He-C
6910.07(l), the individual shall
provide a document signed by his or her employer verifying that the provider is
prohibited from caring for his or her own children while caring for the
employer's children as a condition of the individual's employment and that the
employer is not a license-exempt child care provider.
(v) For individuals who did not find a child
care provider within 30 days when seeking child care through a child care
resource and referral agency pursuant to
He-C
6910.10(s)(1), acceptable
verification shall be a letter from the child care resource and referral agency
stating that the parent has been working with its staff and child care has not
been identified for a specific child.
(w) When a child or parent has had an
in-patient hospital stay within the past 30 days as described in
He-C
6910.10(s)(2), acceptable
verification shall be the discharge statement, hospital record, or a statement
from the attending physician.
(x)
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 an organization or agency, or the educational or training
facility, indicating that the parent is making satisfactory progress as defined
in He-C
6910.03(as).
(y) The following verifications requirements
shall apply to an individual participating in a mental health or substance
misuse treatment program:
(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
for an Individual Participating in a Mental Health or Substance Misuse
Treatment Program," (May 2020) affirming the following:
a. "By signing this form, I authorize the
release of this information to the Department of Health and Human Services
(DHHS). I understand that information will be held in the strictest confidence
and will be reviewed by, or shared with, authorized DHHS staff involved in the
administration of the NH Child Care Scholarship Program"; and
(2) A licensed professional shall
certify ongoing treatment is being provided by completing, signing, and dating
section II of Form 2691 "Verification for an Individual Participating in a
Mental Health or Substance Misuse Treatment Program," (May 2020) certifying the
following:
a. "I am the individual's
attending physician, physician's assistant, advance practice registered nurse,
licensed mental health professional, licensed behavioral health professional,
licensed alcohol and drug counselor, certified recovery support worker or board
certified psychologist and am providing ongoing treatment".
Notes
#7357, eff 9-1-00; amd by #7484, eff 4-28-01; ss and moved by #7723, eff 7-1-02 (from He-C 6910.08 ); amd by #8377, eff 6-21-05; ss by #9209, INTERIM, eff 7-19-08, EXPIRED: 1-15-09
New. #9363, eff 1-17-09; (See Revision Note at part heading for He-C 6910) #9474, eff 6-29-09; ss by #10120, eff 5-7-12
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