Complete ALL sections of the application if you are providing Relative-Only In-Home Child Care or Relative-Only Family Child Care (RO FCC).
Relative-Only: related to ALL children receiving child care assistance as a grandparent, great-grandparent, sibling that lives in a separate residence, aunt or uncle.
Sections 6 and 9: if you are providing In-Home Child Care or Family Child Care (FCC), complete all sections EXCEPT sections 6 and 9; Background Clearance (CBC) required.
Capacity: Family Child Care (FCC) programs: no more than eight children in care at any given time.
Schedule: if the schedule varies, you must provide a schedule for a typical week of care for the child.
Signatures: Section 12 is signed by the provider and Section 13 by the parent/caretaker.
| Question | Answer |
|---|---|
| Form Name | OCFS-LDSS-4699 |
| Form Length | 11 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 33 min |
| Edition | 04/2023 |
| Issuing agency | New York State Office of Children and Family Services |
| Who signs | Provider (Section 12) and parent/caretaker (Section 13) |
| Other names | OCFS-LDSS-4699, OCFS LDSS 4699, LDSS-4699, LDSS 4699, Enrollment Form for Provider of Legally Exempt Child Care |
| Official source | OCFS-LDSS-4699 (Rev 04/2023), New York State Office of Children and Family Services |
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