General Information: The Child Care Plan for Child Care Assistance (CCA) is a communication tool that must be submitted with the initial application for MFIP/DWP Child Care Assistance. It should be completed fully and include all ESP agency information, activity information, the recommended amount of child care (based on approved activities) and provider information. The Child Care Plan is also a communication tool to report change that affects CCA. This includes, but is not limited to:

If the amount of care, the child care provider, or approved activities have changed, an updated child care plan is needed at redetermination.

If the amount of child care needed has increased a Child Care Plan is needed.

If conflicting information is presented, an updated child care plan is needed to clarify.

If the activity reported on the redetermination is the same as the last child care plan, no new child care plan is needed.


Parent one information

Parent two information

Parent activities: Complete all that apply

Start time

End time

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End time

Monday

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Start time

End time

Monday

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Start time

End time

Monday

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End time

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General Information:

  • Child care can be requested during the time parent(s) are in activities and child care provider is open.
  • Child care for school-age children cannot be requested while they are in school.
  • Number of care hours each day reflects up to 2 hours of travel time per day.
  • If using two providers must select primary and secondary provider. Amount of childcare at second provider cannot exceed 20 hours every two weeks.
  • Note: this Child Care Plan is NOT a guarantee of child care payment.

Primary Provider


Number of care hours per day

Monday

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Secondary Provider


Number of care hours per day

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