Michigan parents who qualify for child care assistance use DHS-4025 / MDHHS-4025 – Child Development and Care (CDC) Provider Verification to tell the state which child care provider they picked and when care started. The form lets the Michigan Department of Health and Human Services (MDHHS) link an approved CDC case to a specific provider so that subsidy payments can be issued correctly.
DHS-4025 / MDHHS-4025 typically shows:
✔️ Parent’s (case name), case number, MDHHS office, and specialist contact details.
✔️ Provider’s name, provider ID, address, phone, email, and where care is given (center, group home, family home, or child’s home).
✔️ Each child’s name, date of birth, start date of care, and whether the child is related to the provider (and how).
✔️ Parent’s agreement to program rules, responsibility for costs not covered by CDC, and certification that the information is true.
✔️ A consent checkbox (on the new version) allowing MDHHS to share additional case information with the provider, if the parent chooses.
It gives MDHHS a clear, standardized record of which children are in care with which provider, so the state can authorize and track CDC subsidy payments correctly.
Note: The old DHS-4025 was updated and renumbered as MDHHS-4025. Older DHS-4025 versions were only accepted through July 31, 2025, and now, families must use the current MDHHS-4025 Provider Verification form.
| Question | Answer |
|---|---|
| Form Name | Dhs 4025 Form |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 37 |
| Avg. time to fill out | 30 sec |
| Other names | dhs 4025, dhs cdc provider verification form, child development care provider verification form, mi dhs child |
