The Oregon DHS Child Care Provider form serves as a crucial tool in the engagement between child care providers, parents seeking child care, and the Oregon Department of Human Services (ODHS). This comprehensive form guides providers through the process of registering with ODHS, detailing steps for both licensed and license-exempt care providers. Importantly, it reminds providers about the necessity of adhering to health and safety training, including first aid and CPR certifications, and for those not related to all children in their care, the importance of water quality testing for lead. The form also outlines how to submit the necessary documentation to ODHS and highlights the significant role of the Child Care Resource and Referral (CCR&R) office in assisting with form completion and training arrangements. Notably, the document introduces providers to various scenarios that might affect their licensure requirements, offering a pathway to ensure that all providers meet the health and safety standards mandated by ODHS and OCC (Office of Child Care). Beyond the immediate procedural instructions, the form encapsulates a broader commitment to maintaining high standards in child care, underscoring the importance of background checks and ongoing communication with ODHS regarding any changes in the provider’s status or the care environment. Such detailed guidelines not only aim to streamline the administrative aspect of child care provision but also to elevate the quality and safety of child care across Oregon.
| Question | Answer |
|---|---|
| Form Name | Oregon Dhs Child Care Provider Form |
| Form Length | 16 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 4 min |
| Other names | child care provider listing form, dhs in oregon daycare reimbursent form for foster care, oregon dhs listing form, oregon dhs provider |
Child Care Provider Listing
Form Instructions
Parent: Please immediately give this form to your child care provider to complete.
Provider: For help completing this form contact your local Child Care Resource and Referral
(CCR&R) office. To find an office near you call: CCR&R Centralized Coordination at
Licensing and
»If you are currently licensed with the Office of Child Care (OCC), go to page 4 for instructions.
»If you are not licensed with OCC and:
•You are not related to all children in care.
O You are likely providing
•You are a grandparent,
O You are likely providing
Are you required to be licensed with the Office of Child Care?
Child care providers are legally required to be licensed with OCC unless they are exempt from licensing
How to determine your license or
Please select all the statements below that apply to you.
If you provide care in a home, you are exempt from licensing if:
You are providing care in the home of the child but do not live with the child.
All the children you care for, not including your own children, are from the same family. You are caring for three or fewer children, not including your own children, at any one time. You are related to the children in care by blood, marriage or adoption.
If you provide care in a facility, you are exempt from licensing if:
You do not care for children more than 70 days in a year.
A school district, political subdivision of the state or a governmental agency operates the program. You are operating a
If you meet one of the above exemptions, OCC may not require licensing of your home or facility. To see if you need to be licensed, call OCC at
ODHS uses this information to help determine if you need to be licensed with OCC. This is an informational tool only.
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Instructions for
Training
If OCC does not require you to have a license and you are not related to all children in care, you will need to complete the following before submitting a completed Child Care Provider Listing Form:
•Introduction to Child Care Health & Safety training (take online)
O Online training:
•Recognizing and Reporting Child Abuse and Neglect training
O
O Online training:
•Infant/Toddler CPR/First Aid training
For training locations, contact your local CCR&R at
Attach a copy of your “Infant/Toddler CPR/First Aid Card” to this form if you took this training from another agency besides the local CCR&R.
Note: The director and staff members who work with children in care and volunteers who may have unsupervised access to children are also required to take the above trainings.
Water testing requirements
Please note: Lead testing is not needed if you provide care in the child’s home and you live somewhere else.
OCC can reimburse you for the cost of lead testing. For a reimbursement form and information on how to test your water, visit
For information on preventing exposure to lead, contact OCC at
After completing the above trainings and water testing:
•Complete and sign the attached Child Care Provider Listing Form using black or blue ink.
•Mail the form within 30 days from the date issued in the “ODHS branch use only” section. Mail to the Direct Pay Unit (DPU) at P.O. Box 14850, Salem, OR
•Contact DPU for questions at:
•OCC must conduct a home/facility visit before approving you as a child care provider. This also includes care provided in the child’s home. After ODHS reviews your provider listing form and verifies you have completed trainings, an OCC staff person will contact you to schedule a visit where child care will be provided. The OCC staff person will check to make sure the home/facility meets all
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health and safety requirements as required by OCC and ODHS. The staff person can talk with you about concerns or questions you have and share resources or training material.
OBefore this visit, you may review the OCC’s Health and Safety Checklist. Find the checklist at
Please also see section “Additional information for both relative and
Instructions for
Note: A relative is a grandparent,
Training
If you are not required to be licensed with OCC and you are related to the child or children in care, you will need to complete the following before submitting a completed Child Care Provider Listing Form:
•Introduction to Child Care Health & Safety training (take online)
For more information, go to
After completing the above training:
•Complete and sign the attached Child Care Provider Listing Form using black or blue ink.
•Mail the form within 30 days from the date issued in the “ODHS branch use only” section. Mail to the Direct Pay Unit at P.O. Box 14850, Salem, OR
•Contact DPU for questions at
Additional information for both relative and
Background checks
ODHS conducts FBI fingerprint background checks for
•DPU will submit the completed listing form to the Background Check Unit (BCU) to conduct the background checks. You will receive a letter stating who needs to submit fingerprints. Please read this letter carefully; it will have specific instructions on how to get the required fingerprints.
O Criminal and child protective service records checks are required for the provider, any member of the household who is age 16 or older, and any visitors to the home who may have unsupervised access to a child in care. A visitor is someone who may spend time at the provider’s home during the time child care is provided but does not live in the home. This is likely when the provider needs to visit another area of the home (bathroom, bedrooms, kitchen), leaving the visitor an opportunity for unsupervised access to children.
O In facilities exempt from licensing, the site director and everyone who works in the facility who will have access to the children in care need criminal and child protective service records checks. This includes employees, substitute caregivers, staff and volunteers who may have an opportunity for unsupervised access to children.
Persons who have lived in the state for less than five years will require additional child welfare, sex offender and criminal interstate checks.
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Instructions for
family, certified family, certified center)
Licensed providers with OCC are required to:
•Meet ODHS provider requirements and health and safety standards.
•Complete and sign the attached Child Care Provider Listing Form using black or blue ink.
•Mail the form within 30 days from the date issued in the “ODHS branch use only” section. Mail to the Direct Pay Unit at P.O. Box 14850, Salem, OR
A Child Care Provider Listing Form is required for each site where care is provided. ODHS will
need to list and approve each site to receive subsidy child care payments.
Contact DPU for questions at
Important information for all child care providers
Notice
The Oregon Department of Human Services (ODHS) helps pay child care costs for families receiving child care assistance. The family may have to pay for some of the care, including the first month of service, if ODHS does not approve their provider’s listing before their child starts care.
ODHS helps pay child care costs for families receiving assistance.
Providers are required to meet all ODHS standards and provider requirements to be eligible for payment from ODHS. For full standards and requirements, see the ODHS Child Care Provider Guide (DHS 7492) or visit
•This is not a billing form. You will receive a billing form in the mail if ODHS approves you to receive payment as a child care provider and the parent is eligible for child care assistance.
•The family may also be responsible to pay for some of the care, including the first month of care.
•If there is more than one provider for a child, each provider will receive a percentage of the hours for each month.
•For more information regarding child care, go to the ODHS child care information website:
•By supplying your email address in #3 of the listing form, ODHS will email you important information on the child care program.[LJ2][SE3]
Important contacts
•Direct Pay Unit (DPU): P.O. Box 14850, Salem, OR
•Child Care Resource and Referral Centralized Coordination:
•211info: Dial 211 or text the keyword “children” to 898211 or email children@211.org
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•SEIU — Union for
•AFSCME — Union for OCC licensed providers:
Reporting changes
All child care providers are required to report the following changes to DPU within five days by calling 1-
•Any new arrests, indictments, convictions or involvement with Child Protective Services (Child Welfare) or any other agencies providing child or adult protective services by any of the following:
O You
O Any person living with you age 16 and older O Visitors
O Each person supervising a child in the provider’s absence
O The site director of an exempt child care facility and anyone who works in the facility who has access to the children in care, including employees, substitute caregivers, staff and volunteers and
O Any other person required to be on the listing form.
•Any change to the provider’s name, phone number or address including any location where care is provided
•Any new person (age 16 and older) in the home or facility, including visitors to the home or facility during the hours care is provided who may have unsupervised access to the children in care
•If I am now licensed with OCC or have changed my license type with OCC
•If I am no longer licensed with OCC
•If I no longer meet ODHS provider requirements including health and safety requirements
•If I am now a home care worker for any ODHS Aging and People with Disabilities programs or personal support worker through any Intellectual and Developmental Disability (IDD) or Oregon Health Authority (OHA) Behavioral Health Services program
•If I am a home care worker or personal support worker, I will notify DPU if any changes occur with the type of care I provide or if clients have been added to my care
Failure to report changes may result in a fail status or suspension as a child care provider and you will not be able to receive child care payments.
Frequently asked questions and full standards and requirements
See the ODHS Child Care Provider Guide (DHS 7492) or visit:
Where to submit the completed form
By mail: Direct Pay Unit, P.O. Box 14850, Salem, OR
By fax:
By email: DPU.childcarebilling@dhsoha.state.or.us (PDF only)
Questions? Call
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