Va Form 0730H PDF Details

Ensuring the well-being of children while their parents work is a priority that the Department of Veterans Affairs (VA) takes seriously, particularly for lower-income Federal employees. The VA Child Care Subsidy Program Benefit Payment Request Form, known as VA Form 0730H, stands as a crucial instrument in this endeavor. Introduced under the authority of Public Law 107-67, Section 630, the form facilitates the provision of appropriated funds to assist eligible VA employees with child care costs. It mandates the disclosure of personal information, including Social Security or tax identification numbers, to verify compliance with licensure and regulation, critical for determining eligibility for the child care subsidy. The necessity of attaching detailed child care provider invoices underscores the program's dedication to transparency and accountability. Furthermore, timely submission of this form, following the provision of child care services, ensures the smooth processing of subsidy benefits. The emphasis on clear communication between the employee and the child care provider about the handling of the subsidy benefits highlights the program's respect for the autonomy and financial arrangements of participants. By meticulously outlining the steps to request monthly child care subsidy payments, VA Form 0730H serves as a blueprint for supporting VA employees in balancing their professional and familial responsibilities.

QuestionAnswer
Form NameVa Form 0730H
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesVA0730h va form 0730h

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VA CHILD CARE SUBSIDY PROGRAM

BENEFIT PAYMENT REQUEST FORM

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 furnishes 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 the denial of your request for payment of child care subsidy benefits.

INSTRUCTIONS: Employees approved to participate in the VA Child Care Subsidy Program must use this form to request monthly child care subsidy benefit payments. A separate form must be prepared for each month benefits are requested and should not be submitted until child care services for the month have been provided. A copy of the child care provider's invoice for the month must be attached to each form and mailed to (faxes and e-mail submissions are not acceptable): Department of Veterans Affairs, VA Child Care Subsidy Program Office (05CCSP), 810 Vermont Avenue, NW, Washington, DC 20420. The child care provider's invoice should include the name of the provider or company, invoice number, the provider's Federal tax identification number, a description of services and total cost of monthly services.

Completed forms must be received at VA not later than the last day of the month following the month for which payment is requested. For example, if a subsidy benefit is requested for October 2009, the completed form for October 2009 must be received by VA no later than November 30, 2009.

Please print clearly.

NOTE: You are responsible for the payment of your total child care cost and must pay the full amount on all invoices issued to you by your child care provider. As a participant in the VA Child Care Subsidy Program, you are eligible to receive a subsidy to be applied towards your child care costs. Your monthly child care subsidy will be forwarded to your child care provider on your behalf. Any arrangement you make with your provider regarding the manner in which your child care subsidy benefits are credited to your account is between you and your child care provider.

SECTION I - PARENT/LEGAL GUARDIAN INFORMATION

1.NAME AND HOME ADDRESS OF EMPLOYEE

(Include Street Number, City, State and ZIP Code)

2. HOME PHONE NUMBER

4.WORK ADDRESS (Include Street Number, City, State and ZIP Code)

5. WORK PHONE NUMBER

6. STATION NUMBER

3. HOME E-MAIL ADDRESS (If applicable)

7. WORK E-MAIL ADDRESS (If applicable)

SECTION II - CHILD CARE PROVIDER INFORMATION

1.NAME AND ADDRESS OF CHILD CARE PROVIDER/COMPANY (Include Street Number, City, State and Zip Code)

2. TELEPHONE NUMBER OF CHILD CARE PROVIDER

3. E-MAIL ADDRESS OF CHILD CARE PROVIDER

4A. CHILD'S NAME:

AGE:

4C. CHILD'S NAME:

AGE:

4B. CHILD'S NAME:

AGE:

4D. CHILD'S NAME:

AGE:

5. INDICATE THE MONTH AND YEAR FOR WHICH YOU ARE REQUESTING A SUBSIDY FOR CHILD CARE PROVIDER COSTS (MONTH/YEAR)

/

 

 

 

 

 

 

6. INDICATE BELOW THE FULL CHILD CARE COST FOR EACH WEEK OF THE MONTH YOU ARE REQUESTING A CHILD CARE SUBSIDY BENEFIT

 

 

 

 

 

 

 

 

WEEK 1 ENDING DATE:

WEEK 2 ENDING DATE:

WEEK 3 ENDING DATE:

WEEK 4 ENDING DATE:

WEEK 5 ENDING DATE:

 

MONTHLY TOTAL:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEEK 1 TOTAL CHARGES:

WEEK 2 TOTAL CHARGES:

WEEK 3 TOTAL CHARGES:

WEEK 4 TOTAL CHARGES:

WEEK 5 TOTAL CHARGES:

 

 

$

$

$

$

$

 

$

 

 

 

 

 

 

 

SECTION III - CERTIFICATION AND SIGNATURE OF EMPLOYEE

CERTIFICATION: I certify that the above information is true and correct and that the above child care services were received for the period of time this request covers. I understand that failure to truthfully set forth this information could result in the loss of child care subsidy from the Department of Veterans Affairs.

Employee's Signature

Date of Signature (MM/DD/YYYY)

SECTION IV - FOR APPROVING OFFICE USE ONLY

MONTHLY COST: $

VA PERCENTAGE:

SUBSIDY AMOUNT: $

DISAPPROVED

EXPLANATION:

AUTHORIZING OFFICIAL SIGNATURE:

DATE:

COMMENT:

VA FORM 0730H

FEB 2011

DATE PAID:

INVOICE NUMBER:

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2. The third step is usually to submit the next few fields: CERTIFICATION I certify that the, Employees Signature, Date of Signature MMDDYYYY, SECTION IV FOR APPROVING OFFICE, MONTHLY COST, VA PERCENTAGE, SUBSIDY AMOUNT, DISAPPROVED, EXPLANATION, AUTHORIZING OFFICIAL SIGNATURE, COMMENT, VA FORM, FEB h, DATE PAID, and INVOICE NUMBER.

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