The purpose of this policy bulletin is to inform staff that the following Family Independence Administration (FIA) Child Care forms have been converted to Administration for Children’s Services (ACS) Division of Child Care and Head Start forms. Therefore these FIA forms are now obsolete:
▪ W-274AA CILOPA Recertification Letter
▪ W-274W Child Care Provider Enrollment Supplement
▪ W-274ZZ ACS Child Care Attendance Verification Letter
▪ W-574EE Child Care Fact Sheet Planner
▪ W-574EE (S) Child Care Fact Sheet Planner (Spanish)
▪ W-574FF Proof of ID and Residency For Your Child Care Provider or “Babysitter”
▪ W-667C Child Care Appointment Confirmation and
Contact List
The ACS child care forms are:
▪ CS-274AA CILOPA Recertification Letter
▪ CS-274W Child Care Provider Enrollment Supplement
▪ CS-274ZZ ACS Child Care Attendance Verification Letter
▪ CS-574FF Proof of ID and Residency For Your Child Care Provider or “Babysitter”
▪ CS-667C Child Care Appointment Confirmation and Contact List
▪ ACS Form W-574EE Child Care Fact Sheet Planner
▪ ACS Form W-574EE (S) Child Care Fact Sheet Planner
(Spanish)
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