Va Form 0730D PDF Details

VA Form 0730D is a Department of Veterans Affairs (VA) form that is used to apply for VA benefits. The form can be used to apply for disability compensation, pension, and burial benefits. The form can also be used to apply for education and training benefits, healthcare benefits, home loan guarantees, and other benefits. The form is a lengthy document that requires a great deal of information from the applicant. It is important to complete the form accurately and completely to ensure that the application process goes as smoothly as possible.

The following are some information about va form 0730d. Before you decide to complete the form, it is usually definitely worth examining more details on it.

QuestionAnswer
Form NameVa Form 0730D
Form Length2 pages
Fillable?Yes
Fillable fields1
Avg. time to fill out42 sec
Other names0730a, form, dbq forms, va form 0730d

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

(00) Office of the Secretary

(00CFM) Office of Acquisition, Logistics and Construction (GOE)

(01)Board of Veterans' Appeals

(02)General Counsel

(002)Assistant Secretary for Public & Intergovernmental Affairs

(003)Office of Acquisition, Logistics and Construction (Supply Fund)

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

(004F) Assistant Secretary for Management (Franchise Fund)

(004G) Assistant Secretary for Management (GOE)

005F) Assistant Secretary for Information & Technology (Franchise Fund)

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

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

(007)Assistant Secretary for Operations, Security and Preparedness

(008)Assistant Secretary for Policy & Planning

(009)Assistant Secretary for Congressional & Legislative Affairs

(10C) Veterans Health Administration (Canteen Service)

(10E) Veterans Health Administration - (Medical Administration)

(10F) Veterans Health Administration - (Medical Facilities)

(10J) Veterans Health Administration - (FHCC)

(10M) Veterans Health Administration - (Medical Services)

(10R) Veterans Health Administration - (Research)

(20)Veterans Benefits Administration

(40)National Cemetery Administration

(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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AUG 2012 0730a

MAY NOT BE USED.

 

 

 

 

 

 

 

VA FORM

SUPERSEDES VA FORM 0730a, DATED JUN 2010, WHICH

 

 

 

 

 

 

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

2M. TYPE OF CARE (Check one)

 

 

 

 

 

 

 

 

 

 

CHILD CARE PROVIDER

 

 

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 0730D Online for Free

It is simple to fill out forms making use of our PDF editor. Updating the form document is a breeze in the event you stick to these steps:

Step 1: Click the orange button "Get Form Here" on the following webpage.

Step 2: So, you're on the file editing page. You may add content, edit current data, highlight particular words or phrases, place crosses or checks, insert images, sign the document, erase unrequired fields, etc.

If you want to complete the form PDF, enter the details for all of the segments:

step 1 to filling out va dbq forms download

Enter the necessary details in the field B, DATEOFBIRTH, MM, DD, YYYY C, NAME, OF, CHILDCARE, PROVIDER D, WEEKLY, CHILDCARE, COST E, DATE, OF, ENROLLMENT, MM, DD, YYYY F, TYPE, OF, APPLICATION, Check, only, one I, SOURCE, OF, SUBSIDY J, AMOUNT, OF, SUBSIDY L, TELEPHONE, NUMBER, OF, CHILDCARE, PROVIDER M, TYPE, OF, CARE, Check, one CENTER, BASED VA, BASED FAMILY, HOME, BASED SCHOOL, BASED OTHER, and VA, FORM

va dbq forms download BDATEOFBIRTHMMDDYYYY, CNAMEOFCHILDCAREPROVIDER, DWEEKLYCHILDCARECOST, EDATEOFENROLLMENTMMDDYYYY, FTYPEOFAPPLICATIONCheckonlyone, ISOURCEOFSUBSIDY, JAMOUNTOFSUBSIDY, LTELEPHONENUMBEROFCHILDCAREPROVIDER, MTYPEOFCARECheckone, CENTERBASED, VABASED, FAMILYHOMEBASED, SCHOOLBASED, OTHER, and VAFORM fields to complete

You need to point out the vital details in the A, NAME, OF, SECOND, CHILD C, NAME, OF, CHILDCARE, PROVIDER F, TYPE, OF, APPLICATION, Check, only, one SECTION, II, CHILD, INFORMATION, Continued B, DATEOFBIRTH, MM, DD, YYYY D, WEEKLY, CHILDCARE, COST E, DATE, OF, ENROLLMENT, MM, DD, YYYY I, SOURCE, OF, SUBSIDY J, AMOUNT, OF, SUBSIDY CHILDCARE, PROVIDER M, TYPE, OF, CARE, Check, one CENTER, BASED VA, BASED FAMILY, HOME, BASED and SCHOOL, BASED section.

step 3 to finishing va dbq forms download

The area F, TYPE, OF, APPLICATION, Check, only, one I, SOURCE, OF, SUBSIDY J, AMOUNT, OF, SUBSIDY CHILDCARE, PROVIDER M, TYPE, OF, CARE, Check, one CENTER, BASED VA, BASED FAMILY, HOME, BASED SCHOOL, BASED and OTHER will be where to place all parties, ' rights and obligations.

va dbq forms download FTYPEOFAPPLICATIONCheckonlyone, ISOURCEOFSUBSIDY, JAMOUNTOFSUBSIDY, CHILDCAREPROVIDER, MTYPEOFCARECheckone, CENTERBASED, VABASED, FAMILYHOMEBASED, SCHOOLBASED, and OTHER fields to insert

Step 3: As you press the Done button, your ready form can be easily exported to each of your devices or to electronic mail given by you.

Step 4: Make sure you stay away from potential complications by making a minimum of a pair of copies of the document.

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .