DEPARTMENT OF HUMAN RESOURCES/CHILDCARE MANAGEMENT AGENCY 2026

1. Click ‘Get Form’ to open the DEPARTMENT OF HUMAN RESOURCES/CHILDCARE MANAGEMENT AGENCY Child Care Subsidy Referral Form in the editor.
2. Begin by entering the date at the top of the form. This is essential for record-keeping.
3. Fill in the 'Health Care Provider or Caregiver' section with your name and contact details, ensuring accuracy for communication purposes.
4. In the 'Applicant Information' section, provide all required details such as Parent Name, Spouse Name (if applicable), Date of Birth, Race, SSN (optional), and Sex for both parents.
5. Complete the 'Employer Information' fields with your employer's name, address, and phone number to establish employment verification.
6. List children needing care by filling in their names, dates of birth, race, sex, and whether parental fees are waived.
7. Indicate the start and end dates for care needs along with selecting full-time or part-time care options.
8. Provide details about the licensed child care provider including their name and address. Ensure they are registered to receive funding.
9. Finally, sign the form as both the applicant and employer’s authorized designee before submitting it via email to childcare.subsidy@dhr.alabama.gov.

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