Dhs 4025 form 2010-2025

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  1. Click ‘Get Form’ to open the dhs 4025 form 2010 in the editor.
  2. Begin by filling in the 'Case Name', 'Case Number', and 'Date' at the top of the form. Ensure accuracy as this information is crucial for processing.
  3. Next, complete the 'DHS Office', 'District', and 'Specialist' sections. This identifies your local DHS office and assigned specialist.
  4. In the 'Child Development and Care Provider Verification' section, provide all requested details about the child care provider, including their name, address, and contact information.
  5. List all children under care in the designated area, including their names and dates of birth. Indicate if you are related to each child.
  6. Review both sides of the form carefully. Sign and date on page 2 as required before submitting it back to your local DHS office.

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The form required to be completed by all employees prior to departing is Form 132-01, DHS Exit Checklist. The Federal legislation that supports the DHS records management mission is the Federal Records Act of 1950.
License Exempt- Unrelated Provider must provide care in the childs home. Provider must pass a comprehensive background check that includes an FBI fingerprint. The provider is responsible for the cost of the background check. Provider must participate in an annual health and safety visit.
For instance, most states and territories do not require an in-home child care provider to be licensed if they provide care on an occasional basis, provide care in your home, or are related to the children in their care.
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The Caregiver Child Exemption allows adult children to care for their parents at home as opposed to moving them into a Medicaid-funded assisted living residence or nursing home. (As a side note, Medicaid will not pay for the room and board portion of assisted living.

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