Sacramento County Stage One Child Care - Request for Reimbursement 2145 Form-2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out Section 1 and Section 2, which are designated for parent information. Enter your name, contact details, and your child's information including their date of birth and age.
  3. In Section 3, provide the child care provider's details. Specify the type of provider and enter their billing address along with the relevant rates for care.
  4. Proceed to Section 4, where you will summarize the billing. Ensure that all hours and days match what is recorded on the back of the form. Use decimals for amounts if completing electronically.
  5. Sign and date both sides of the form after ensuring all information is accurate. Remember to submit it within three months of care completion to avoid payment denial.

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Enter the Full Name, Date of Birth, and Age of the child in each section. Enter the School Name, Track, and Grade if the child is in a preschool program separate from daycare, or if the child is Kindergarten thru high school. Complete the Travel Time each way from child care to the parent activity.
Note: The W-4 form 2024 steps are the same as the W-4 form 2025 steps. Step 1: Enter your personal information. Step 2: Account for all jobs you and your spouse have. Step 3: Claim your children and other dependents. Step 4: Make other adjustments. Step 5: Sign and date your form.
Average Child Action Childcare Provider hourly pay in California is approximately $27.58, which is 82% above the national average.

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