Dss 2941 form-2026

1. Click ‘Get Form’ to open the dss 2941 form in the editor.
2. Begin by selecting the type of facility from the options provided: Child Care Center, Family Child Care Home, Group Child Care Home, or Church.
3. Enter the Facility Name and County in the designated fields.
4. Fill in the Days of Operation and provide the Facility Address along with a contact Telephone number.
5. If applicable, enter a different Mailing Address. Then, input the Name of Director/Operator and indicate if overnight care is requested by selecting 'Yes' or 'No.'
6. Specify the Hours of Operation and include Directions for locating the facility, especially if it’s in a hard-to-find area.
7. Ensure to sign and date the form as the Director/Operator before submitting it.
8. Lastly, provide the Name and Telephone Number of a Facility Contact Person, choosing from Director, Operator, Sponsoring Agency Rep., or Owner.

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