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Declaration of caregiver services form

Atlanta Service Center 2025

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4.8 out of 5

162 votes

The document is a declaration form from the U.S. Department of Education's Atlanta Service Center, intended for caregivers to provide truthful information regarding their services and payments for child care. It includes sections for caregiver and customer details, payment amounts, and a legal warning about the consequences of providing false information.

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Send us department of education form declaration of cargiver services via email, link, or fax. You can also download it, export it or print it out.

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Click ‘Get Form’ to open the Atlanta Service Center document in the editor.
Begin by entering your Taxpayer ID or SSN in the designated field. This information is crucial for identification purposes.
Fill in the Caregiver Name, Address, and Daytime Telephone Number. Ensure that all details are accurate to avoid any issues.
In the Customers Name section, input the name of the individual receiving care. Follow this by detailing the payment structure: specify the Month and amount paid per week/month for each child listed.
List each child's name and age in the provided fields, along with the corresponding amount charged for their care.
Finally, sign and date the form at the bottom to validate your declaration before submitting it as instructed.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (162 Votes)
2003	4.9 Satisfied (41 Votes)

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Driving directions to Atlanta Civic Center, 395 Piedmont Ave NE, Atlanta - Waze.

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What other names was the Atlanta Civic Center known by?

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Opened in 1968, the Atlanta Civic Center quickly became a prominent venue for the arts in the Southeast. Although the Civic Center closed its doors in 2015 due to declining attendance and the need for extensive renovations, there are exciting plans for its future.

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declaration of caregiver services

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