Child Care Assistance (CCAP) Forms

Access the CCAP application and related CCAP forms below.

3 simple ways to access the CCAP application and forms:

1. Download forms on our website
2. Request forms over the phone
3. Pick up forms in-person

Download CCAP Forms

Read form instructions carefully and complete all questions on the form. Write “N/A” for questions that do not apply to you.

Child Care Application Form

• CCAP Application- English
  
• CCAP Application- Spanish

Wage Verification Form

• Wage Verification Form-English
• Wage Verification Form-Spanish

Self-Employment Record Form

• Self-Employment Record Form- English
• Self-Employment Record Form- Spanish

W-9 Form

Download the W-9 form to be paid for child care services. Your W-9 form will be submitted to the Illinois Department of Human Services Comptroller’s office for processing.

Telephone Billing Agreement

Get your child care payments quicker! Download and complete the Telephone Billing Agreement to be able to call your child care payments through the Child Care Telephone Billing System.

• Telephone Billing Agreement
• Acuerdo para Facturación por Teléfono del Cuidado de Niños

Debit Card Form

Choose the Illinois Debit MasterCard to receive your child care assistance payments! Complete the Illinois Debit MasterCard form and submit to the Illinois Department of Human Services to receive an Illinois Debit MasterCard.

• Debit Card Form
• Formulario Opción de Pago con Tarjeta Débito MasterCard de Illinois

Childcare Registration Fee Certification Form

• Childcare Registration Fee Certification Form- English
• Childcare Registration Fee Certification Form- Spanish