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Forms for Families

Translations:

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Note: All forms are in PDF format.

Child Care Application

This form is for families who are applying for child care for the first time. You can also apply online through MyCity.

Form #

Form Name

Purpose

CFWB-012, 012A, 012B Child Care Assistance Application Package

Application for child care assistance. Package includes:

  • Application (CFWB-012)
  • Instructions (CFWB-012A)
  • Submission Checklist (CFWB-012B)
  • Immigration Memo
  • Voter Registration Form
CFWB-012 Translations: العربية | বাংলা | Español | 简体中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français


Child Care Application - Supplemental Forms

These forms are for families who are applying for child care for the first time. They may be required to submit along with your child care application.

Self Employment Income Information Attestation

For use by self-employed applicants.

Form #

Form Name

Purpose

CFWB-005

Vocational, Education and Training Verification

Submit this form if your reason for care is school or vocational training attendance. This form documents your attendance at an approved education or training program.

CFWB-005 Translations: العربية | বাংলা | Español | 简体中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

CFWB-015

Referral to Employer for Income Information

Use this form to verify your income if pay stubs are not available.

CFWB-015 (Español)

(Español) Remisión al Empleador para Información de Ingresos

Use este formulario para verificar sus ingresos si los recibos de sueldo no están disponibles.

CFWB-026

Work Search Record

Use this form if your reason for care is looking for work if you do not have a current benefits rate letter from New York State Unemployment Benefits.

CFWB-026 Translations: العربية | বাংলা | Español | 简体中文 | 繁體中文Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

CFWB-027

Housing Attestation

Use this form if your reason for care is homelessness, and you are living doubled-up, in a place not meant for human habitation, in a hotel/motel, or in another living situation. Families living in shelter (including Humanitarian Emergency Relief Centers) should not submit this form, and should instead submit a Shelter Residency Letter.

CFWB-027 Translations: العربية | বাংলা | Español | 简体中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

CFWB-031

Self Employment Income Information Attestation

For use by self-employed applicants.

CFWB-031 Translations: العربية | বাংলা | Español | 简体中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

CFWB-058

Caretaker Attestation

For use by legal guardian, caretaker relative or other person who lives with the child.

CFWB-058 Translations: العربية | বাংলা | Español | 简体中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

CFWB-067

Residency Attestation

Use this form if you do not have other proof of New York City residency.

CFWB-067 Translations: العربية | বাংলা | Español | 简体中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français


Child Care Recertification

This form is for families who already have child care assistance and are completing their annual recertification. This was mailed to you prior to your recertification date.

Form #

Form Name

Purpose

CFWB-078

Child Care Assistance Recertification
Submission Instructions and Checklist

Instructions and checklist for submitting child care assistance recertification.

CFWB-078 Translations: العربية | বাংলা | Español | 简体中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français


Special Needs Rate Application

These forms are for families who already have child care assistance and want to apply for a special needs payment rate for their child care provider.

Form #

Form Name

Purpose

CFWB 001 Special Needs Payment Rate Application Use this form if you are a Parent or Guardian who currently receives an ACS voucher and you are interested in requesting a Special Needs payment rate.


Suspected Fraud – Referral Form

Form #

Form Name

Purpose

CFWB-009

Referral of Suspected Childcare Subsidy Fraud

Use this form to report child care subsidy fraud in NYC.

CFWB-009 Translations: العربية | বাংলা | Español | 简体中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français


Information for Families

Form #

Form Name

Purpose

N/A

Early Care & Education Programs for Families Experiencing Homelessness

For information on all early care and education services available for families in shelter or temporary housing.

Early Care & Education Programs for Families Experiencing Homelessness Translations: العربية | বাংলা | Español | 简体中文 | 繁體中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français

N/A

Early Care & Education Programs for New York City Families

For information on all early care and education services available for eligible families in New York City.

Early Care & Education Programs for New York City Families Translations: العربية | বাংলা | Español | 简体中文 | Русский | 한국어 | Polski | اردو | Kreyòl ayisyen | Français