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Click ‘Get Form’ to open the mi cdc in the editor.
Begin by entering your Provider Name and Provider ID Number at the top of the form. Ensure that the ID number is the 7-digit number from your DHS-198 authorization.
Fill in the Pay Period Number corresponding to your billing dates, and indicate the Page Number if you are using multiple pages for more than four children.
For each child, enter their Full Name in alphabetical order, followed by Begin Time and End Time for their attendance. Remember to specify AM or PM clearly.
Record any Absence Hours for each child as needed, ensuring they do not exceed 360 hours per fiscal year. Initials from a parent or authorized representative are required for verification.
Finally, sign and date the form at the bottom, and include your Confirmation Number found on your DHS-105 invoice.
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Apr 10, 2026 Find Michigan birth and death statistics from the National Vital Statistics System. Marriage and divorce rates also are available forRead more
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