ECE 021 (formerly known as CS-1067)-2025

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The document is a recertification form for household information related to child care services. It requires the applicant to provide personal details, confirm the accuracy of their information, indicate changes in household members and their statuses, and specify reasons for needing child care. Additionally, it includes sections for adding new children or household members and assessing eligibility for child care vouchers.

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Click ‘Get Form’ to open the ECE 021 in the editor.
Begin by entering your Case Number and Program/Provider Number at the top of the form. Ensure these details are accurate for proper processing.
In the 'Name and Address' section, clearly print your name, telephone number, and address. If any information has changed, indicate it in the provided lines.
Answer whether this is a two-parent/caretaker household by selecting 'Yes' or 'No'.
Select your reason for child care from the options provided. If your reason has changed, ensure you update it accordingly.
For household members, indicate their marital and military status using the codes provided. Check 'Same', 'Remove', or 'Change' as applicable.
Add any new children or household members at the bottom of the form, ensuring to attach copies of birth certificates for children being added.

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