Child Care Provider Verification (Form 1863)-2025

1. Click ‘Get Form’ to open the Child Care Provider Verification (Form 1863) in the editor.
2. Begin by entering the Provider’s Name and Physical Address. Ensure you include a reachable telephone number.
3. Next, fill in the Parent’s Name and Physical Address along with their contact number.
4. Input the Child Care Provider Resource Identification Number accurately, leaving unused spaces blank.
5. Indicate whether the child care provider is licensed by checking 'Yes' or 'No'. If not licensed, provide details on the total number of children cared for and how many are related.
6. For each child receiving care, enter their full name, date of birth, relationship to the provider, and when care began.
7. Select where child care is provided by checking the appropriate box: Child’s Home, Provider’s Home, or Child Care Center.
8. Finally, ensure both Parent/Guardian and Provider sign and date the form to certify that all information is accurate.

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