Our Strong Start supports child care professionals with a team of trained navigators who connect them with grant opportunities, help troubleshoot any barriers in the licensing process, and address any concerns about starting or expanding their business. To date, the governor has expanded access to free or low cost child care for 150,000 more kids and their families, awarded nearly $1 billion in grants to nearly 6,000 child care businesses, and provided bonuses up to $1,000 for 38,000 child care professionals. To apply for a new license or renew a license, use the applicable applications below. Important Notice: Providers who anticipate receiving payments from the Michigan Department of Health and Human Services (MDHHS) or the Michigan Department of Education (MDE). ?n&/Q2[Gk2Ax2$ - ?)*por~$g*O #|}}r51yq!k]Iz PDF BCAL-5001, Staffing Plan: Child Care Centers, Part 1: All Staff LARA is dedicated to bridging the gap between civilian and military . 1 MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS CHILD CARE LICENSING BUREAU SPECIAL INVESTIGATION REPORT I. IDENTIFYING INFORMATION License #: DC630019539 Investigation #: 2023D0432005 Complaint Receipt Date: 11/30/2022 Investigation Initiation Date: 12/05/2022 Report Due Date: 01/29/2023 Licensee Name: Berkley Public Schools Licensee Address: 14700 Lincoln If you have any problems and/or need assistance during the registration process, please contact SIGMA Vendor Payment Support at 1-855-443-6424. <>/Metadata 257 0 R/ViewerPreferences 258 0 R>> CDC Provider Login - Michigan Department of Health and Human Services Today, Gov. /Filter /FlateDecode Click on the name of the facility for more detailed information including online inspection reports completed on or after July 1, 2002. Received Medical Treatment if applicable and known Phone Number of Treating Physician / Medical Facility / Hospital if applicable Any Handicaps Health Problems or Exceptions Listed on the Child s Health Records if applicable If Fire Describe Damage PERSON S NOTIFIED law enforcement fire marshal parent/legal guardian etc. Make these fast steps to edit the PDF Child care renewal application online free of charge: Sign up and log in to your account. Create your eSignature, and apply it to the page. Corporations, Securities & Commercial Licensing Bureau. %PDF-1.5 Corporation Forms; Limited Liability Company Forms; Limited Liability Partnership Form; . 4 0 obj The notebook must include all licensing study and special investigation reports issued and related corrective actions developed after 5/27/10. Child care staffing shortages throughout the state have made it difficult to find caregivers for our youngest Michiganders. Renewal application for permit to conduct a child care service: Fill of Licensing and Regulatory Affairs (LARA), Child Care Licensing Bureau (CCLB), has summarily suspended the group child care home license of Connie Rookus, located at . PDF Ownership Interest Disclosure Self-Certification of Transportation Provisions for Centers CCL-5044 - Word, Volunteer Certification for Field Trip Transportation CCL-5046 - PDF If you have questions concerning filing your taxes, see page 5 of the CDC Handbook or contact your tax preparer. After that, your bcal 4605 is ready. a. I am responsible for any child care charges for periods before my provider completes the Great Start to Quality Orientation. [R 400.1936 (1)] If yes, list: License Application Packet - Michigan This message area was updated Tuesday, February 21, 2023. PDF Michigan Child Care Background Check Consent and Disclosure An Online Resource for Skilled Immigrants. The Word documents are fillable and are intended for electronic completion. Obtain access to a GDPR and HIPAA compliant platform for optimum simpleness. To apply for aChild Care Home or Center licensesee the instructions below and apply online at MiLogin. 4-10) Previous editions obsolete. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Add the Child care renewal application for editing. Disclaimer: Licensing and registration records are made available on this website by LARA to provide immediate access to information for the Family and Group Home Increased Capacity and Ratio Request - Word Version, Family and Group Home Increased Capacity and Ratio Request PDF Version, Waiver for Decreasing Capacity Fillable Word Version, Waiver for Decreasing Capacity PDF Version, Request of Child Care Forms CCL-2021 PDF, Request of Child Care Forms CCL-2021 Word, Child Care Licensing Information Request - CCL 001 -PDF, Child Care Licensing Information Request - CCL 001 - Word, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 PDF, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 Word, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - PDF, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - Word, Background Check and Fingerprinting Information, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200, Notification of Changes in Status-Family and Group Child Care Home - CCL-1485 - PDF, Notification of Changes in Status-Family and Group Child Care Home - CCL-1485 - Word, Medical Clearance Request - CCL-3704 - PDF, Medical Clearance Request - CCL-3704 - Word, Child Information Record - CCL-3731 - PDF, Child Information Record - CCL-3731 - Word, Child Information Record - CCL 3731-AR (Arabic), Documento de Informacin del Nio Estado de Michigan - CCL-3731-SP, Zoning Approval for Group Child Care Homes - CCL-3748 - PDF, Zoning Approval for Group Child Care Homes - CCL-3748 - Word, Declaracin/Recibo de Nios en Cuidado - CCL-3900-SP, Child in Care Statement/Receipt - CCL-3900 - PDF, Child in Care Statement/Receipt - CCL-3900 - Word, Training Record Family/Group Child Care Homes - CCL-4590 PDF, Training Record Family/Group Child Care Homes - CCL-4590 - Word, Assistant Caregiver Certifications - CCL-4595 - PDF, Assistant Caregiver Certifications - CCL-4595 - Word, Home Fire and Tornado Drill Record - CCL-4593 - PDF, Home Fire and Tornado Drill Record - CCL - 4593 - Word, Licensing Notebook Summary Sheet - CCL-5052 - PDF, Licensing Notebook Summary Sheet - CCL-5052 - Word, Request for Modification of the Terms of the License - CCL-5054 - PDF, Request for Modification of the Terms of the License - CCL-5054 - Word, Variance Request Early Childhood Program Director Fillable Word Version, Variance Request Early Childhood Program Director PDF Version, Variance Request School-Age Program Director Fillable Word Version, Variance Request School-Age Program Director PDF Version, Variance Request Lead Caregiver Fillable Word Version, Variance Request Lead Caregiver PDF Version, Child Care Licensing Information Request - BCHS-CCL 001 - PDF, Child Care Licensing Information Request - BCHS-CCL 001 - Word, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 - PDF, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 - Word, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - Word. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. The Child Care Organizations Act (1973 PA 116) provides authority to establish these rules. n# 6H=f,=`S0p~gAs,o(W #1KIUHaF|mI5Ddf)u Click onthe Register button. As new information becomes available, we will update this message area. Use signNow to electronically sign and share Lara bcal for eSigning. << Go to the Chrome Web Store and add the signNow extension to your browser. Business Entity Forms. Also see Important Notice below regarding reimbursement from MDHHS. As these reports contain confidential information they are redacted before being posted on the Child Care Licensing Bureau (CCLB) website. Start completing the fillable fields and carefully type in required information. Biden's Chips Act Child Care Plan Is Better Than Nothing x][o8~/H I&2; 8n H$^[5`tGY'ow/6={{g?efy^mI_&O'/? The statutes listed are referenced in the licensing rules. Incident Report CCL-4605 - Word, Parent Notification of the Licensing Notebook CCL-5053 PDF, Parent Notification of the Licensing Notebook CCL-5053 - Word, Multiple Occupancy Documentation for Child Care Centers CCL- 2118 PDF, Multiple Occupancy Documentation for Child Care Centers CCL- 2118 Word, Ownership Interest Disclosure CCL-2119 PDF, Ownership Interest Disclosure CCL-2119 Word. These child care forms include printable curriculum forms and child care lesson plans. 1903 (1d)] All children who reside in the child care home have been immunized as recommended by the Department of Community Health. Go digital and save time with signNow, the best solution for electronic signatures. Lara Incident Report - Fill Out and Sign Printable PDF Template | signNow A Camp SITE and Camp PROGRAM are licensed separately. State of Michigan Department of Licensing and Regulatory Affairs Lansing Out Strong Start is a program focusing on recruiting new child care entrepreneurs and helping current child care entrepreneurs expand. Once youve finished putting your signature on your bcal 4605, decide what you want to do after that - save it or share the doc with other people. Use professional pre-built templates to fill in and sign documents online faster. PDF MICHIGAN CHILD CARE BACKGROUND CHECK CONSENT AND DISCLOSURE - WAAC programs 5m. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Keystone State. Reminder Regarding Temporary Rate Increases and End Dates: For additional information, please see the Child Care Provider Rates and Payments section of the CDC Handbook. +z7?A}W Additional questions may be directed to the appropriate Regional Office of Child Development: *FOR QUESTIONS REGARDING YOUR PENNSYLVANIA CHILD ABUSE HISTORY CLEARANCE APPLICATION, CONTACT CHILDLINE AT 1-877-371-5422. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. An assistant caregiver may care for your child in my absence. You may be required to add "Michigan.gov" to your compatibility view settings for the application to be submitted successfully. Reducing Barriers to Licensure for Military Families, Corporations, Securities & Commercial Licensing, Find / Verify a Licensed Professional or Business, Make a Complaint About a Licensed Professional or Business, Look Up Underground Storage Tank Information, Access the Online Liquor Ordering (OLO) System, Regulated Products, Professions, & Businesses Activities, Resources for Veterans & Military Families, https://dev.michigan.local/som/json?sc_device=json, Go to An Online Resource for Skilled Immigrants, Medical Marijuana Program (MMMP) Patients & Caregivers, Learn About CRA Rules, Laws & Regulations, Find / Verify a CRA Licensed Professional or Business, Make a Complaint About a CRA Licensed Professional or Business, Track Marijuana Inventory - Statewide Marijuana Monitoring System (Metrc), Find Panel, Public Hearing & Workgroup Information, Find a Disciplinary Action Report or Document, Learn About CCL Rules, Laws & Regulations, Find / Verify a CCL Licensed Professional or Business, Make a Complaint About a CCL Licensed Professional or Business, Apply for / Renew a BCC License or Permit, Find / Verify a BCC Licensed Professional or Business, Make a Complaint About a BCC Licensed Professional or Business, Learn About Examinations & Continuing Education, Find / Verify a BCHS Licensed Professional or Business, Make a Complaint About a BCHS Licensed Professional or Business, Go to Corporations, Securities & Commercial Licensing, Find / Verify a CSCL Licensed Professional or Business, Make a Complaint About a CSCL Licensed Professional or Business, Contact the Michigan Liquor Control Commission, Local Government & Law Enforcement Resources, Go to Michigan Office of Administrative Hearings and Rules, Administrative Hearings Frequently Asked Questions, Request to Attend a Hearing (for Media Professionals), Go to Michigan Indigent Defense Commission, Learn About Continuing Legal Education (CLE), Make a Complaint or Inquiry About a Utility Provider, Compare Natural Gas Utilities Options (MI Gas Choice), Submit an Underground Utilities Locate Request (MISS DIG 811), Learn About Natural Gas & Pipeline Providers, Learn About Rules of Practice and Procedure, Find / Verify a BPL Licensed Professional or Business, Make a Complaint About a BPL Licensed Professional or Business, Michigan Automated Prescription System (MAPS), Find / Verify a UCC Licensed Professional or Business, Make a Complaint About a UCC Licensed Professional or Business, Go to Apply for / Renew a License or Permit, Go to Find / Verify a Licensed Professional or Business, Go to Make a Complaint About a Licensed Professional or Business, Go to Look Up Underground Storage Tank Information, Go to Look Up a Controlled Substance (MAPS), Go to Access the Online Liquor Ordering (OLO) System, Go to Look Up a Disciplinary Action Report, Go to Submit a Request for Information (FOIA), Go to Regulated Products, Professions, & Businesses Activities, Go to Requesting Information from LARA (FOIA), Go to Resources for Veterans & Military Families, Vehicle Protection Product Warrantor Forms. Whitmer Launches New Program to Help Entrepreneurs Open New Child Care Programs, Increase Availability of Affordable Care for Parents, LARA Hosts Child Care Provider Access Fair In Petoskey. Homes for the Aged Exemption from Licensure. The PDF versions are not fillable and are intended for printing. PFaD,;5UVrf$@`{&0,TrG,@(vb(v6Fr}Y[*ALewgALuchj%]FLz8U). 3;Vpf !fn'~Y1qU."c.@*vz 4b%"Jt}L ,`z'Up\[8UDz9^OeK6'r#{*%4pSA2A0v69k"0qq4~-#^:Z9fYuKOw35 1 Incorrect Star Ratings: A system issue has caused some licensed and registered providers to be paid at a rate that is incorrect for their star levels. signNow makes eSigning easier and more convenient since it offers users a number of extra features like Merge Documents, Invite to Sign, Add Fields, etc. %PDF-1.7 Application for Child Care Plan Review (BCHS-FS-13), Child Care Center Notice of Arraignment or Conviction CCL-1486 - PDF, Child Care Center Notice of Arraignment or Conviction CCL-1486 - Word, Child Information Record - CCL-3731 Web Proected, Child Information Record - BCAL 3731-AR (Arabic), Documento de Informacin del Nio Estado de Michigan - BCAL-3731-SP, Written Information Packet Documentation CCL-4340 - PDF, Written Information Packet Documentation CCL-4340 - Word, Change of Use Space Request for School-Age Programs Located in Schools CCL-4342 - PDF, Change of Use Space Request for School-Age Programs Located in Schools CCL-4342 - Word, Lead Hazard Risk Assessment Summary CCL-4344 - PDF, Lead Hazard Risk Assessment Summary CCL-4344 - Word, No Change in Building Construction Declaration CCL-2129 - PDF, No Change in Building Construction Declaration CCL-2129 - Word, Infant/Toddler Primary Caregiver Documentation CCL-4557 - PDF, Infant/Toddler Primary Caregiver Documentation CCL-4557 - Word, Center Fire and Tornado Drill Record - CCL-4593 - PDF, Center Fire and Tornado Drill Record - CCL-4593 - Word, Staffing Plan: Child Care Center CCL-5001 - PDF You can now submit your Pennsylvania Child Abuse History Clearance Request, Application for Certificate of Compliance for Center Group and Family, CD 51 (formerly CY 51) Child Health Assessment, CD 357 Documentation of Emergency Plan Delivery, CD 357 Request For Waiver of Child Care Facility Regulation, CY 863 Verbal Request for Release of Child, CY 867 Emergency Contact/Parental Consent Form, CY 113 Pennsylvania Child Abuse History Clearance, CY999 Consent/Release of Information Authorization Form, SP 4-164 Request for Criminal Record Check, PW 29A Day Care Services Enrollment/Attendance Record. This policy will be in effect through September 30, 2023. The signNow extension gives you a variety of features (merging PDFs, including multiple signers, and many others) to guarantee a better signing experience. <> We apologize for this inconvenience. The PDF versions are not fillable and are intended for printing. (3) An applicant for a child care center license must disclose the ownership interest in the child care center as . Once registered in SIGMA VSS, you will receive a SIGMA Vendor ID that will allow you to get paid for services performed. PDF DHS-4025, Child Development and Care Provider Verification "# +bc5iA F WXJT3H>.Le|e0}etGyJFx{ln(oTm=uYwQhW#Cf~53a4~I &!p"fy}L Eo$% A full-time day care spot can take months or even years to secure, especially for the youngest children; 80% of day care spots are reserved for children age 3 or older. Summer 2022 Child Care Stabilization Grants:To go directly to information about the Summer 2022 grants, click the following link: Summer 2022 Child Care Stabilization Grants. Look through the document several times and make sure that all fields are completed with the correct information. An Online Resource for Skilled Immigrants. Licensing forms - Redirect to DHS Home Page Michigan Department of Licensing and Regulatory Affairs Z49u0w~eC>?'reS@`v5qupy&V&k>!iLA)fILMa5pV\TAkIn2=]=J dYTewz]Ttk} XEnfG2k]O5A]03XD^O&dQKR//' =nTk6.d`| />LvXQ{$=mya+bP_$aJt> )26hkK+AHEYb&xz?XEgu``5+`q.wBLc#XC$*E9QK \+1iv58mQk:5A/0GcYG%}0K'cw"e,x_Dkps{S6B}(7C6i>rW "1=rW +N9! LARA is dedicated to bridging the gap between civilian and military employment and helping veterans gain and retain employment. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. CDC Provider Login Enter your 7-digitProvider ID and 6-character PIN, then press the Submit Button This message area was updated Tuesday, February 21, 2023. Whitmer Makes $23 Million Bipartisan Investment to Start and Expand Child Care Businesses, Application Open 11/7, Gov. Forms for child foster care Minnesota Adoption and Child Foster Care Application DHS-4258A (9-17) (PDF) Minnesota Corporate Child Foster Care Application DHS-4258H (8-17) (PDF) Parental Consent for Swaddling an Infant DHS-7218 (7-13) (PDF) Physician Directive for Alternative Infant Sleep Position DHS-7216 (7-13) (PDF) Forms for family child care endobj f Licensing Rules for Child Care Centers and Homes provide minimum standards for regulated child care providers. Reports may be obtained by making a Freedom of Information Act request. !7]/;xrWY-e [3Q E7z_;$h;~|9sHo>9dN'~_Nw{\J Ywe;]/W.*|hZ0=)>+e*_.rho~x-w+yq6/X)y^4X5b 9~d|3~3UnZ9F1>nA0ww?,pg)_}$:_;t1c2-@57d"|Al@$!Dz&=bA!DO4 g39ATe]h- With signNow, it is possible to eSign as many documents in a day as you need at a reasonable price. Choose the correct version of the editable PDF form from the list and get started filling it out. Printing and scanning is no longer the best way to manage documents. Select the area where you want to insert your eSignature and then draw it in the popup window. Reports may be obtained by making a Freedom of Information Act request. If you are a provider/licensed child care providerthat will be expecting compensation for services performed for MDHHS/MDE clients, you need to register with the Statewide Integrated Governmental Management Applications (SIGMA) Vendor Self Service (VSS) atwww.michigan.gov/sigmavss. Fire Safety Provisions - BCAL-0722, Child Care Center Compliance Record, Part 4. !tp,3+X =-N;HY(!8h y:ApBeX&Ct.e'me-q%mw#&*'?SejsiyyKcc\Z[5?X2eYcp)sr. You will find a camp licensing overview, camp rules and statutes, forms, and resources to assist you at http://www.Michigan.gov/laracamps. Caring for Mi Future is a $100 million strategy to open 1,000 new child care programs by the end of 2024. Providers do not need to take any action at this time. I will inform you before each occurrence. Reducing Barriers to Licensure for Military Families, Corporations, Securities & Commercial Licensing, Find / Verify a Licensed Professional or Business, Make a Complaint About a Licensed Professional or Business, Look Up Underground Storage Tank Information, Access the Online Liquor Ordering (OLO) System, Regulated Products, Professions, & Businesses Activities, Resources for Veterans & Military Families, https://dev.michigan.local/som/json?sc_device=json, Go to An Online Resource for Skilled Immigrants, Medical Marijuana Program (MMMP) Patients & Caregivers, Learn About CRA Rules, Laws & Regulations, Find / Verify a CRA Licensed Professional or Business, Make a Complaint About a CRA Licensed Professional or Business, Track Marijuana Inventory - Statewide Marijuana Monitoring System (Metrc), Find Panel, Public Hearing & Workgroup Information, Find a Disciplinary Action Report or Document, Learn About CCL Rules, Laws & Regulations, Find / Verify a CCL Licensed Professional or Business, Make a Complaint About a CCL Licensed Professional or Business, Apply for / Renew a BCC License or Permit, Find / Verify a BCC Licensed Professional or Business, Make a Complaint About a BCC Licensed Professional or Business, Learn About Examinations & Continuing Education, Find / Verify a BCHS Licensed Professional or Business, Make a Complaint About a BCHS Licensed Professional or Business, Go to Corporations, Securities & Commercial Licensing, Find / Verify a CSCL Licensed Professional or Business, Make a Complaint About a CSCL Licensed Professional or Business, Contact the Michigan Liquor Control Commission, Local Government & Law Enforcement Resources, Go to Michigan Office of Administrative Hearings and Rules, Administrative Hearings Frequently Asked Questions, Request to Attend a Hearing (for Media Professionals), Go to Michigan Indigent Defense Commission, Learn About Continuing Legal Education (CLE), Make a Complaint or Inquiry About a Utility Provider, Compare Natural Gas Utilities Options (MI Gas Choice), Submit an Underground Utilities Locate Request (MISS DIG 811), Learn About Natural Gas & Pipeline Providers, Learn About Rules of Practice and Procedure, Find / Verify a BPL Licensed Professional or Business, Make a Complaint About a BPL Licensed Professional or Business, Michigan Automated Prescription System (MAPS), Find / Verify a UCC Licensed Professional or Business, Make a Complaint About a UCC Licensed Professional or Business, Go to Apply for / Renew a License or Permit, Go to Find / Verify a Licensed Professional or Business, Go to Make a Complaint About a Licensed Professional or Business, Go to Look Up Underground Storage Tank Information, Go to Look Up a Controlled Substance (MAPS), Go to Access the Online Liquor Ordering (OLO) System, Go to Look Up a Disciplinary Action Report, Go to Submit a Request for Information (FOIA), Go to Regulated Products, Professions, & Businesses Activities, Go to Requesting Information from LARA (FOIA), Go to Resources for Veterans & Military Families, applicable Licensing Rules for your Adult Foster Care Home. b. I understand that if I am a child care staff member, I shall report to the child care facility within 3 business days after I have been arraigned for or convicted of 1 or more of the crimes listed in MCL 722.115r. % Child Care Licensing Forms - Michigan Add the PDF you want to work with using your camera or cloud storage by clicking on the. 3 0 obj Michigan Office of Administrative Hearings and Rules. endobj This information is updated once a day. The Michigan Department of Licensing and Regulatory Affairs ( LARA ), originally the Department of Commerce among other names, is a principal department in the Michigan executive branch that oversees employment, professional licensing, construction, and commerce . >;Njd*-B^do,P4{upzTKpZlWz eV +NP?o]1`dj?oQW5A~fA6X pj; State of Michigan - Licensing and Regulatory Affairs - Child Care Licensing Bureau 722.115m Child care center, group child care home, or family child care home; requirements for licensure; disclosure of ownership interest. Michigan Office of Administrative Hearings and Rules. Open the doc and select the page that needs to be signed. 4 0 obj ?tfmV:gH3e4C+ \-lSXnD\fMC"o.2nDZBzfvwk o;3/ Connect to a smooth web connection and start completing forms with a fully legitimate electronic signature within minutes. Gov. Playground Inspection Certification Summary CCL-5047 Word, Incident Report CCL-4605 - PDF An Online Resource for Skilled Immigrants. Proudly founded in 1681 as a place of tolerance and freedom. )4sysa(!T+@Ghy/& p s9u"t%@N?r4, *iT?95:~ <6wcJ\H7vtH{! Environmental Health Provisions - BCAL-4668, Child Care Center Compliance Record, Part 3. Forms & Publications - Michigan Select the document you want to sign and click. Department of Human Services > Find a Document > For Providers > Child Care Forms Central Region (717) 772-7078 or (800) 222-2117 Northeast Region (570-963-4371 or (800) 222-2108 Southeast North and Southeast South Region (215) 560-2541 or (800) 346-2929 Western Region (412) 565-5183 or (800) 222-2149 Michigan Child Care Licensing: Your Go-To Guide - Procare Solutions Whitmer Makes $23 Million Bipartisan Investment to Start and Expand Child Care Businesses, Application Open 11/7 October 27, 2022

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