Va Form 0730A PDF Details

In addressing the intricacies of child care subsidy applications for lower-income Federal employees, the Department of Veterans Affairs employs the VA 0730A form as a critical tool. This form not only aids in collecting necessary personal information and financial details but also ensures compliance with regulatory mandates stemming from Public Law 107-67, which authorizes the use of appropriated funds to support child care costs. The meticulous design of the form allows for a comprehensive evaluation of eligibility, hinging on the disclosure of sensitive information such as Social Security Numbers, family income data, and child care provider details. Applicants are required to provide an array of information, ranging from employment details to family income and child care expenses, underlining the program's commitment to financial transparency and integrity. The process underscores the importance of accuracy and completeness in submission, as any deficiencies can lead to the denial of subsidy benefits. Such thorough vetting procedures not only aim to support the financial well-being of qualifying families but also echo the overarching commitment of the Department of Veterans Affairs to the welfare of its employees' families, ensuring that the child care needs of the nation's service members are met with due diligence and respect.

QuestionAnswer
Form NameVa Form 0730A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names2010, REAPPLICATION, 0730b, ccrms va

Form Preview Example

OMB Number: 2900-0717

Respondent Burden: 20 minutes

CHILD CARE SUBSIDY APPLICATION FORM

PRIVACY ACT STATEMENT - Public Law 107-67, § 630 (September 2001) confers regulatory authority on the Department of Veterans Affairs for agency use of appropriated funds for child care costs for lower income Federal employees. Public Law 104-134 (April 26, 1996) requires that any person doing business with the Federal Government furnish a Social Security Number or tax identification number. This is an amendment to title 31, Section 7701. The primary use of these Social Security Numbers will be for identification purposes in determining eligibility for child care subsidy. The primary use of information regarding family income (copies of pay statements and tax returns), name of current child care provider, copies of the provider's license, statement of compliance, and information about other child care subsidies is also used to determine eligibility for child care subsidy. Disclosure of the above information is voluntary, but failure to provide all of the requested information may result in denial of your application.

SECTION I - PARENT/LEGAL GUARDIAN INFORMATION

NOTE: Applications that are not fully completed or do not contain the information listed below will not be processed and will be returned to the applicant through the submitting HR office. If you do not provide all of the information requested, you will not receive a subsidy award. When more than one parent works for the Federal Government, subsidies cannot be awarded for the child/children by more than one Federal agency.

1.NAME (Last, first, middle initial)

2. SOCIAL SECURITY NUMBER

3. JOB SERIES/GRADE

4.ORGANIZATIONAL CODE (See list of codes at bottom of Section I)

5.WORK ADDRESS (Include street number, city, state and ZIP Code)

6. WORK E-MAIL ADDRESS

7. WORK TELEPHONE NUMBER/EXTENSION

8.HOME ADDRESS (Include street number, city, state and ZIP Code)

9. HOME E-MAIL ADDRESS

 

 

 

 

 

 

 

10. HOME TELEPHONE NUMBER

 

 

 

 

 

11. CATEGORY OF

12. IS SPOUSE A

13. NAME OF SPOUSE (Last, first, middle initial)

 

14. GRADE OF SPOUSE

 

PARENT

 

FEDERAL EMPLOYEE?

 

 

 

 

 

 

 

SINGLE

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. EMPLOYING AGENCY OF SPOUSE

 

 

 

COUPLE

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. TOTAL FAMILY INCOME AS REPORTED ON ADJUSTED GROSS INCOME LINE OF MOST RECENT IRS FORM 1040 OR 1040A.

$

 

 

 

 

 

 

 

 

 

 

 

ORGANIZATIONAL CODES

 

(007)

Assistant Secretary for Operations, Security and Preparedness

(00)

Office of the Secretary

 

(008)

Assistant Secretary for Policy and Planning

 

(009)

Assistant Secretary for Congressional & Legislative Affairs

 

(00CFM)

Assistant Secretary for Construction & Facilities Management

 

(01)

Board of Veterans' Appeals

 

(002)

Assistant Secretary for Public & Intergovernmental Affairs

 

(02)

General Counsel

 

(003)

Office of Acquisition, Logistics & Construction

 

(10M)

Veterans Health Administration - Medical Services

 

(004A) Assistant Secretary for Management (Finance Fund)

 

(10F)

Veterans Health Administration - Medical Facilities

 

(004G) Assistant Secretary for Management (GOE)

 

 

 

(10R)

Veterans Health Administration - Research

 

(004F)

Assistant Secretary for Management (Franchise Fund)

 

(10E)

Veterans Health Administration - Medical Administration

 

(005G) Assistant Secretary for Information & Technology (GOE)

 

(10C)

Veterans Health Administration - Canteen Service

 

(005F)

Assistant Secretary for Information & Technology (Franchise Fund)

 

(20)

Veterans Benefits Administration

 

(006E) Corporate Senior Executive Management Office

 

(40)

National Cemetery Administration

 

(006G) Assistant Secretary for Human Resources & Administration (GOE)

 

(50)

Inspector General

 

 

 

 

 

 

 

 

SECTION II - CHILD INFORMATION

INSTRUCTION: List information for all children for whom you are applying for a subsidy. (If you are applying for more than three children please attach the pertinent information to this form.)

1A. NAME OF FIRST CHILD

 

 

 

 

 

1B. DATE OF BIRTH (MM/DD/YYYY)

 

 

 

 

 

 

 

1C. NAME OF CHILD CARE PROVIDER

 

 

 

1D. WEEKLY CHILD CARE COST

1E. DATE OF ENROLLMENT (MM/DD/YYYY)

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

1F. TYPE OF APPLICATION? (Check only one)

 

 

 

 

 

1G. ENTER LAST DAY WITH PREVIOUS

NEW FAMILY

REAPPLICATION (Previously enrolled, not current.)

 

PROVIDER (MM/DD/YYYY)

 

 

 

ANNUAL RECERTIFICATION

CHANGING PROVIDER INFORMATION

 

 

 

 

 

 

 

 

ADDING/CHANGING FAMILY INFORMATION

(Complete Item 1H)

 

 

 

 

 

 

(Attach license, schedule of fees, and VA Form 0730b.)

 

 

 

 

 

 

 

 

1H. IS ANY OTHER FORM OF STATE, COUNTY OR LOCAL SUBSIDY BEING

1I. SOURCE OF SUBSIDY

 

1J. AMOUNT OF SUBSIDY

RECEIVED FOR THE CHILD(REN)?

 

 

 

 

 

 

 

YES (If "YES," complete items 1J and 1K and submit a copy of

NO

 

 

$

 

award letter.)

 

 

 

 

 

 

 

1K. ADDRESS OF PROVIDER (Include street number, city, state and ZIP Code)

1L. TELEPHONE NUMBER

1M. TYPE OF CARE (Check one)

 

 

 

 

 

OF CHILD CARE PROVIDER

 

 

 

 

 

 

 

 

 

CENTER-BASED

VA-BASED

 

 

 

 

 

 

FAMILY HOME-BASED

SCHOOL-BASED

 

 

 

 

 

 

OTHER

 

 

 

 

 

 

 

 

 

VA FORM

0730A

SUPERSEDES VA FORM 0730a, DATED JUN 2010, WHICH

 

 

 

AUG 2012

 

MAY NOT BE USED.

 

 

 

 

SECTION II - CHILD INFORMATION (Continued)

2A. NAME OF SECOND CHILD

 

 

 

2B. DATE OF BIRTH (MM/DD/YYYY)

 

 

 

 

 

2C. NAME OF CHILD CARE PROVIDER

 

 

2D. WEEKLY CHILD CARE COST

2E. DATE OF ENROLLMENT (MM/DD/YYYY)

 

 

 

 

 

$

 

 

 

 

 

 

2F. TYPE OF APPLICATION? (Check only one)

 

 

 

2G. ENTER LAST DAY WITH PREVIOUS

 

 

NEW FAMILY

REAPPLICATION (Previously enrolled, not current.)

PROVIDER (MM/DD/YYYY)

 

 

 

 

 

 

 

ANNUAL RECERTIFICATION

CHANGING PROVIDER INFORMATION

 

 

 

 

 

 

 

 

 

 

ADDING/CHANGING FAMILY INFORMATION

(Complete Item 1H)

 

 

 

 

 

(Attach license, schedule of fees, and VA Form 0730b.)

 

 

 

 

2H. IS ANY OTHER FORM OF STATE, COUNTY OR LOCAL SUBSIDY BEING

2I. SOURCE OF SUBSIDY

2J. AMOUNT OF SUBSIDY

 

 

RECEIVED FOR THE CHILD(REN)?

 

 

 

$

 

 

YES (If "YES," complete items 2J and 2K and submit a copy of

NO

 

 

 

 

 

 

 

 

award letter.)

 

 

 

 

 

 

 

 

 

 

 

2K. ADDRESS OF PROVIDER (Include street number, city, state and ZIP Code)

2L. TELEPHONE NUMBER OF CHILD CARE PROVIDER

2M. TYPE OF CARE (Check one)

 

CENTER-BASED

VA-BASED

FAMILY HOME-BASED

SCHOOL-BASED

OTHER

 

3A. NAME OF THIRD CHILD

 

 

 

3B. DATE OF BIRTH (MM/DD/YYYY)

 

 

 

 

 

3C. NAME OF CHILD CARE PROVIDER

 

 

3D. WEEKLY CHILD CARE COST

3E. DATE OF ENROLLMENT (MM/DD/YYYY)

 

 

 

$

 

 

 

 

 

 

3F. TYPE OF APPLICATION? (Check only one)

 

 

 

3G. ENTER LAST DAY WITH PREVIOUS

NEW FAMILY

REAPPLICATION (Previously enrolled, not current.)

PROVIDER (MM/DD/YYYY)

 

ANNUAL RECERTIFICATION

CHANGING PROVIDER INFORMATION

 

 

 

ADDING/CHANGING FAMILY INFORMATION

(Complete Item 1H)

 

 

 

(Attach license, schedule of fees, and VA Form 0730b.)

 

 

 

 

3H. IS ANY OTHER FORM OF STATE, COUNTY OR LOCAL SUBSIDY BEING

3I. SOURCE OF SUBSIDY

3J. AMOUNT OF SUBSIDY

RECEIVED FOR THE CHILD(REN)?

 

 

 

 

YES (If "YES," complete items 3J and 3K and submit a copy of

NO

 

$

award letter.)

 

 

 

 

3K. ADDRESS OF PROVIDER (Include street number, city, state and ZIP Code)

3L. TELEPHONE NUMBER OF

3M. TYPE OF CARE (Check one)

 

CHILD CARE PROVIDER

 

 

 

CENTER-BASED

VA-BASED

 

FAMILY HOME-BASED

SCHOOL-BASED

 

OTHER

 

SECTION III - SIGNATURE AND CERTIFICATION OF PARENT/LEGAL GUARDIAN

I certify that the above information is true and complete to the best of my knowledge. I understand that failure to truthfully set forth this information could result in loss of child care subsidy from the Department of Veterans Affairs. I further agree to inform my local Human Resources (HR) office within 10 days if any of the above information changes. I understand that awards for child care subsidy are made on a first-come, first-served basis. I understand that failure to inform my local HR office of any changes in status may jeopardize my chances of receiving child care subsidy through the Department of Veterans Affairs Child Care Subsidy Program.

If I answered "YES," in Part I, block 12, I certify that my spouse has not applied for a child care subsidy from his/her Federal agency.

(Signature)

(Date of signature (MM/DD/YYYY))

RESPONDENT BURDEN - Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection, including suggestions for reducing this burden, to the VA Clearance Officer (005R1B), 810 Vermont Avenue, NW, Washington, DC 20420. DO NOT send requests for benefits to this address.

VA FORM 0730a, AUG 2012, PAGE 2

How to Edit Va Form 0730A Online for Free

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Stage no. 1 of filling out E-MAIL

2. Just after the previous array of fields is completed, go on to enter the relevant details in these: A NAME OF FIRST CHILD, B DATE OF BIRTH MMDDYYYY, C NAME OF CHILD CARE PROVIDER, D WEEKLY CHILD CARE COST, E DATE OF ENROLLMENT MMDDYYYY, F TYPE OF APPLICATION Check only, NEW FAMILY, REAPPLICATION Previously enrolled, ANNUAL RECERTIFICATION, ADDINGCHANGING FAMILY INFORMATION, CHANGING PROVIDER INFORMATION, G ENTER LAST DAY WITH PREVIOUS, H IS ANY OTHER FORM OF STATE, I SOURCE OF SUBSIDY, and J AMOUNT OF SUBSIDY.

J AMOUNT OF SUBSIDY, E DATE OF ENROLLMENT MMDDYYYY, and F TYPE OF APPLICATION Check only of E-MAIL

3. Completing A NAME OF SECOND CHILD, B DATE OF BIRTH MMDDYYYY, SECTION II CHILD INFORMATION, C NAME OF CHILD CARE PROVIDER, D WEEKLY CHILD CARE COST, E DATE OF ENROLLMENT MMDDYYYY, F TYPE OF APPLICATION Check only, NEW FAMILY, REAPPLICATION Previously enrolled, ANNUAL RECERTIFICATION, ADDINGCHANGING FAMILY INFORMATION, CHANGING PROVIDER INFORMATION, G ENTER LAST DAY WITH PREVIOUS, H IS ANY OTHER FORM OF STATE, and YES If YES complete items J and K is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Part number 3 of filling in E-MAIL

4. Now proceed to this next portion! In this case you've got all these A NAME OF THIRD CHILD, B DATE OF BIRTH MMDDYYYY, C NAME OF CHILD CARE PROVIDER, D WEEKLY CHILD CARE COST, E DATE OF ENROLLMENT MMDDYYYY, F TYPE OF APPLICATION Check only, NEW FAMILY, REAPPLICATION Previously enrolled, ANNUAL RECERTIFICATION, ADDINGCHANGING FAMILY INFORMATION, CHANGING PROVIDER INFORMATION, G ENTER LAST DAY WITH PREVIOUS, H IS ANY OTHER FORM OF STATE, I SOURCE OF SUBSIDY, and J AMOUNT OF SUBSIDY blanks to fill out.

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