Cs 274W Form PDF Details

The Cs 274W form is an important document for any student who wishes to pursue a career in the field of computer science. This form must be filled out by each student and submitted to their advisor, along with other necessary forms, before they are able to start taking courses at the university level. It is also required that this form be updated after completing each semester in order to show what classes were taken and which ones were passed successfully. It's important for students to keep track of these forms because many universities will not allow them into certain programs or courses until they have completed the appropriate prerequisites.

Here's some data to help you determine the time it will take to finalize the cs 274w form.

QuestionAnswer
Form NameCs 274W Form
Form Length2 pages
Fillable?Yes
Fillable fields100
Avg. time to fill out20 min 34 sec
Other namesform cs 274w, hra child care forms nyc, cs 274w child care enrollment supplement, cs 274w enrollment

Form Preview Example

CS-274W (FACE)

REV. 4/08

Child Care Provider Enrollment Supplement*

To be used with LDSS-4699/LDSS-4700 for all unregulated providers

PARENT/CARETAKER'S NAME:

CASE NUMBER:

ADDRESS:

TELEPHONE:

SOCIAL SECURITY NUMBER (OPTIONAL, SEE BELOW):¹

ACCIS CASE NUMBER:

PROVIDER'S NAME:

DATE OF BIRTH:²

ADDRESS WHERE CARE IS GIVEN:

PROVIDER'S ADDRESS (IF DIFFERENT):

TELEPHONE:

PROVIDER’S SOCIAL SECURITY/LICENSE NUMBER/EIN

¹The parent/caretaker may, but does not have to, list his/her Social Security number.You cannot be required to disclose your Social Security number as a condition of eligibility for child care services. If provided, your Social Security number will be used to assist in identifying your child care file. It may also be used by Federal, State and local agencies to prevent duplication of services and fraud, and for Federal reporting.

2Legally-responsible relatives (parents, stepparents, and legal guardians) cannot be paid as child care providers for their own child(ren).

3If the provider is less than 18 years old, the Employment of Minors Form must be completed.

Provider/Agency Name: ___________________________________________________________________

ACCIS Provider Number (if available): _______________________________________________________

Provider's License Type: _________________________ License Number: _________________________

Expiration Date: ________ / ________ / ________

MM

DD

YYYY

Provider Rate (All providers, except ACS-contracted programs, must complete this section.) My weekly child care rates are as follows:

 

INFANT

TODDLER

PRESCHOOL

SCHOOL-AGE

Indicate the rate charged for each age level

Under 18

18 months –

3 years –

6 – 12 years

 

months

under 3 years

under 6 years

 

 

 

 

 

Full time (30 hours or more per week)

 

 

 

 

 

 

 

 

 

Part time (15 – 29 hours per week)

 

 

 

 

 

 

 

 

 

Hourly (1 – 14 hours per week but

 

 

 

 

less than 3 hours per day)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*ATTENTION: 1. Regulated/licensed providers are not required to complete the LDSS-4699 or the LDSS-4700. They should complete only pages 1 and 2 of this form and return to the parent/legal guardian. Regulated providers without an ACCIS number must also submit a copy of their license along with the competed CS-274W.

2.Informal providers must provide documentation of BOTH their identification and their address in order to be paid by ACS. Please ask your JOS/ACS Worker for the Proof of ID and Residency for Your Child Care Provider or "Babysitter" (CS-574FF), which is the list of approved types of ID.

CS-274W (REVERSE)

REV. 4/08

Indicate the weekly schedule(s) of child care services for the child(ren) listed below:

Child’s

CHILD'S NAME

 

 

 

CHILD'S NAME

 

 

 

CHILD'S NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MONTH

DAY

YEAR

MONTH

DAY

YEAR

MONTH

DAY

YEAR

Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date Care

MONTH

DAY

YEAR

MONTH

DAY

YEAR

MONTH

DAY

YEAR

 

 

 

 

 

 

 

 

 

 

 

 

Began

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weekly

From

 

 

To

From

 

 

To

From

 

 

To

Schedule

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Monday

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tuesday

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wednesday

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Thursday

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Friday

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Saturday

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sunday

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OFFICE

Total Hours

 

 

 

Total Hours

 

 

 

Total Hours

 

 

 

per Week

 

 

 

per Week

 

 

 

per Week

 

 

 

USE

 

 

 

 

 

 

 

 

 

ACS Child

 

 

 

ACS Child

 

 

 

ACS Child

 

 

 

ONLY

 

 

 

 

 

 

 

 

 

 

Care Rate

 

 

 

Care Rate

 

 

 

Care Rate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I acknowledge that receiving payment from the City of New York for child care services provided does not make me an employee of the City of New York. I am an employee of the parent/legal guardian of the child for whom I provide care.

Provider Certification

I am enrolling this child in a child care program. I understand that I will be paid only after the child's attendance data is received by ACS and for so long as the above parent/guardian is engaged in an FIA-approved activity or employed. If the parent/guardian fails to meet these criteria, I will be sent a letter from ACS informing me that ACS will no longer pay for child care. I agree that the amount I am charging this parent is not more than the amount I charge for other children of the same age. I understand that I cannot be paid if I do not list all my rates.

I will allow the parent/guardian of the children named on this form unlimited access to his/her children and the premises and will make myself available whenever the children are in my care.

I certify that the statements above are accurate and true to the best of my knowledge. I understand that providing false information may lead to the suspension or termination of payments and the recovery of any payments to which I was not entitled.

Provider's Name (print clearly): ____________________________________ Official Title (if applicable): _________________

Signature: ________________________________________________________________________ Date: _________________

Parent/Guardian Certification

I certify that I have reviewed the above information and that it is correct. I understand I must report any changes to ACS.

Parent/Guardian's Name: ___________________________________________________________________________________

Parent/Guardian's Signature: _________________________________________________________ Date: _______________

For Agency Use Only:

Is child care authorized for this applicant/participant? Yes No

Agency-approved start date for child care: ________ / ________ / ________

MM DD YYYY

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portion of fields in nyc hra child care forms

Please provide the demanded details in the Provider/Agency Name:, ACCIS Provider Number (if, Provider's License Type:, Expiration Date: ________ /, YYYY, Provider Rate (All providers, My weekly child care rates are as, Indicate the rate charged for each, INFANT Under 18 months, TODDLER, PRESCHOOL, 18 months – under 3 years, 3 years –, under 6 years, SCHOOL-AGE, 6 – 12 years, and Full time (30 hours or more per space.

Completing nyc hra child care forms stage 2

Put down all data you are required inside the space Hourly (1 – 14 hours per week but, and *ATTENTION: 1.

nyc hra child care forms Hourly (1 – 14 hours per week but, and *ATTENTION: 1 blanks to complete

The Child’s Name, Date of Birth, Date Care Began, Weekly Schedule, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, CHILD'S NAME, CHILD'S NAME, CHILD'S NAME, MONTH, DAY, YEAR, MONTH, DAY, YEAR, MONTH, DAY, YEAR, MONTH, DAY, YEAR, MONTH, DAY, YEAR, MONTH, DAY, YEAR, From, From, and From area will be the place to indicate the rights and responsibilities of each side.

Finishing nyc hra child care forms part 4

End by reviewing the next fields and filling them in as required: Sunday, OFFICE, USE ONLY, Total Hours per Week, ACS Child Care Rate, Total Hours per Week, ACS Child Care Rate, Total Hours per Week, ACS Child Care Rate, I acknowledge that receiving, Provider Certification I am, I will allow the parent/guardian, I certify that the statements, and Provider's Name (print clearly):.

stage 5 to finishing nyc hra child care forms

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