DsHS 18-607 provides specific instructions for the completion of the Determination of Medically Handicapped Children form, also referred to as Form 607. The instructions are outlined in a clear and concise manner, making it easy for anyone to understand. In addition, important information is included regarding what is required to complete the form accurately. This ensures that all pertinent data is collected and that no mistakes are made when submitting the form. If you have any questions about completing this form, be sure to consult with your healthcare provider or local Dshs office.
Question | Answer |
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Form Name | Form Dshs 18 607 |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | verification, subsidy, care, dshs 18 607 child care verification |
STATE OF WASHINGTON
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DIVISION OF CHILD SUPPORT (DCS)
Child Care Verification
TO: |
CASE NUMBER: |
The Division of Child Support (DCS) needs verification of your child care expenses for the period.
Please have your child care provider complete a separate Child Care Verification Response (page 2 of this form) for each child listed below. Then you must date and sign each response form, attach proof of payment for the care provided, and return it to DCS at the address listed below. Proof of payment may be receipts or copies of cancelled checks. Return
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Children's Names |
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AUTHORIZED REPRESENTATIVE |
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DIVISION OF CHILD SUPPORT |
Return the completed response form(s) to:
DIVISION OF CHILD SUPPORT
PO BOX 11520 |
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TACOMA WA |
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calling area |
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TTY/TDD services available for the speech or hearing impaired.
Visit our web site at: www.dshs.wa.gov/dcs
No person because of race, color, national origin, creed, religion, sex, age, or disability, shall be discriminated against in employment, services, or any aspect of the program's activities. This form is available in alternative formats upon request.
FG VER: (1.5)
CHILD CARE VERIFICATION |
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DSHS |
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STATE OF WASHINGTON
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DIVISION OF CHILD SUPPORT (DCS)
Child Care Verification Response
Complete a separate form for each child listed on page 1.
DCS Case Number
Child Care Provider Name and Address
Child Care Provider Telephone Number (include area code) ( |
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Child's Name |
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I am paid $ |
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for this child. Of this amount, I receive |
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$ |
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subsidy from Washington State or another state or government agency per month for this child. |
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Enter the amounts you received from the custodian that Washington State or any other state or government agency did not subsidize. This page has space for 12 months of payments. Attach additional sheets if needed.
Amount |
Period (month/year) |
Amount |
Period (month/year) |
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$ |
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$ |
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$ |
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$ |
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$ |
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$ |
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$ |
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$ |
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$ |
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$ |
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$ |
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$ |
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I declare under penalty of perjury, under the laws of the state of Washington, that the foregoing is true and correct. I understand that DCS will use the information I have provided for child support purposes and will become public record. DCS may disclose the information to the noncustodial parent upon written request to DCS and pursuant to public disclosure policy.
Date |
Child Care Provider Signature |
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Date |
Parent / Custodian Signature |
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FG VER: (1.5)
CHILD CARE VERIFICATION |
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DSHS |
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