Dss form 2902-2026

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Click ‘Get Form’ to open the dss form 2902 in the editor.
Begin with Section 1A: Provider Information. Fill in the name of your facility, owner, and director. Ensure you provide the Facility FEIN No. or Owner’s Social Security No., along with the complete street address and contact details.
In Section 1B, answer questions regarding participation in programs like ABC Child Care and USDA Food Program. Check the appropriate boxes for meal provision methods and indicate if your facility policies have been updated.
Complete the certification statements at the end of the form by providing your initials and signature, confirming that all information is accurate.
If applicable, fill out Section 2 for DSS licensing staff only, ensuring to check whether it’s a new application or renewal and provide necessary capacity details.

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