Va Form 0730B PDF Details

If you’re a veteran in need of benefits, the VA Form 0730B is an essential document for filing your claim. This form helps veterans provide vital information about their military service, disability rating and personal particulars to the Department of Veterans Affairs (VA). It’s commonly used by veterans who are looking to get compensation for service-related disabilities or those attempting to receive pension, education assistance and other advantages due to previous military experience. Understanding what VA Form 0730B is and how it works could be beneficial toward getting access to much needed financial aid from the government.

QuestionAnswer
Form NameVa Form 0730B
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesva0730b, 0730b, NW, licensure

Form Preview Example

CHILD CARE PROVIDER INFORMATION

(For the Child Care Subsidy Program)

PRIVACY ACT STATEMENT - Public Law 107-67, Section 630 (November 12, 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 (SSN) and tax identification numbers will be for identification purposes in assuring licensure and/or regulation compliance. This compliance is necessary for the purpose of determining Federal employee 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.

RESPONDENT BURDEN - Public reporting burden for this collection of information is estimated to average 10 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 (005E3), 810 Vermont Avenue, NW, Washington, DC 20420. DO NOT send requests for benefits to this address.

INSTRUCTION: This information is required by law for the agency administrator of the Child Care Subsidy Program to verify licensure and/or regulation status. Once you are notified by a VA employee that they submitted an application for child care subsidy from the Department of Veterans Affairs, please complete this form and return it to the parent. Please attach a copy of your latest license and/or regulatory document and schedule of fees.

PART I - PARENT INFORMATION

1.NAME OF PARENT/LEGAL GUARDIAN WITH CHILD IN THE PROVIDER'S CARE

2. FEDERAL AGENCY OF PARENT

Department of Veterans Affairs

PART II - PROVIDER INFORMATION

1. TYPE OF PROVIDER (Check only one)

 

 

 

 

 

CENTER BASED

FAMILY HOME BASED CARE

VA CHILD CENTER

SCHOOL-BASED CARE

OTHER FEDERAL CHILD CARE

 

 

 

 

 

 

 

 

 

 

 

 

2. CHILD CARE SERVICES (Check only one)

 

 

 

 

 

FULL-TIME CARE

BEFORE SCHOOL CARE

AFTER SCHOOL CARE

BEFORE AND AFTER SCHOOL CARE

 

 

 

 

3. NAME OF CHILD CARE PROVIDER

 

 

 

4.ADDRESS OF CHILD CARE PROVIDER (Include street number, city, state, ZIP Code)

5.PROVIDER E-MAIL ADDRESS

6.PROVIDER TELEPHONE NUMBER

7.TAX IDENTIFICATION NO. OR SOCIAL SECURITY NO.

8. PROVIDER FAX NUMBER

9.LICENSE NUMBER OF PROVIDER

10.STATE IN WHICH LICENSE IS ISSUED

11.LICENSE EXPIRATION DATE

(MM/DD/YYYY)

PART III - CHILD INFORMATION

INSTRUCTION: Please furnish the information below and attach a copy of your latest license and/or regulatory document and schedule of fees.

 

 

C. DOES THE

 

 

CHILD RECEIVE

A. NAME OF EACH CHILD IN SECTION I

B. ENROLLMENT

ANY OTHER

PARENT'S FAMILY ENROLLED

DATE

SUBSIDY? (If

"YES," complete

(Last, first, middle initial)

(MM/DD/YYYY)

D and E.)

 

 

 

 

 

 

 

 

YES

NO

D. SOURCE OF SUBSIDY

E. AMOUNT OF

SUBSIDY

F. TOTAL WEEKLY

FEE FOR CHILD

$

$

$

$

$

$

PART IV - CERTIFICATION AND SIGNATURE OF PROVIDER

CERTIFICATION: I certify that the above information is true and correct to the best of my knowledge. I understand that it is a Federal crime under United States Code 18, Section 1001, to make a false statement on this form. If I make a false statement, I agree to be subject to criminal prosecution and punishment including a fine, imprisonment, or both.

1. NAME OF PROVIDER

2. TITLE OF PROVIDER REPRESENTATIVE

3. SIGNATURE OF PROVIDER

4.DATE SIGNED

(MM/DD/YYYY)

VA FORM

0730B

Supersedes VA Form 0730b, NOV 2000,

JUL 2007

 

which will not be used.

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Completing this document calls for focus on details. Ensure that all required fields are done accurately.

1. You will want to fill out the 005E3 correctly, hence be mindful while filling in the parts including all of these fields:

Part # 1 of filling out YYYY

2. Once your current task is complete, take the next step – fill out all of these fields - YES, CERTIFICATION I certify that the, PART IV CERTIFICATION AND, NAME OF PROVIDER, TITLE OF PROVIDER REPRESENTATIVE, SIGNATURE OF PROVIDER, DATE SIGNED MMDDYYYY, VA FORM JUL, and Supersedes VA Form b NOV which with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

YYYY writing process clarified (part 2)

It is possible to get it wrong when filling out your DATE SIGNED MMDDYYYY, thus make sure you reread it before you decide to send it in.

Step 3: Once you've glanced through the details entered, click on "Done" to conclude your form. Grab your 005E3 when you register at FormsPal for a free trial. Readily get access to the pdf form from your personal account, with any modifications and changes being automatically synced! FormsPal is dedicated to the personal privacy of all our users; we always make sure that all personal information entered into our system stays secure.

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