Child Care Assistance Program Direct Deposit
1. Complete the Information on the Name and Address of the bank that will receive the child care payments. Make sure to tell us if this is a "Business" account or a "Personal" account.
2. Select Account Type. Will the funds be deposited to a checking or a savings account? Select one.
3. Information about you. You must print your name, DHS Provider ID (the 10- digit number that appears on your attendance sheet; starts with zeroes), a phone number where we can reach you.
4. Signature. You must sign the form. The form will be returned to you if not signed and this will delay your direct deposit.
5. Required Documents to attach to the form.
6. Business Checks. If you are a certified Family Provider with business checks showing just the name of your home daycare (for example "Mary's Little Lambs Home Daycare"), YOU MUST provide a letter from the bank to prove that you have signing rights to the account.
7. Once we receive your form and required documentation, it will take 2 payroll runs before you see your DHS payment deposited to your account.The first payroll you will receive a paper check; the next payroll your DHS payment will be deposited to your account.You will continue to receive a Provider Payment Report (previously known as the Vendor Payroll or "stub") listing all the children that were approved for payment.
Send this form to:
The Department of Human Services, Office of Financial Management is authorized to initiate Direct Deposit of my Child Care Provider Payments to my account at the Financial Institution below:
(bank or credit union)_________________________________________________
 Checking Account**
ATTACH A VOIDED BLANK CHECK from the checking account to which the direct deposit will be made. Your name and current address must be printed on the check. If you cannot provide a proper voided check, you must provide a letter from your financial institution, which includes your name, address, bank routing number and account number. The letter must be on bank letterhead and signed by a bank representative. DO NOT SEND DEPOSIT SLIPS OR BANK STATEMENTS. Your name must appear on the account and the account must be with a United States financial institution.
 Savings Account**
ATTACH A LETTER FROM YOUR FINANCIAL INSTITUTION with your name, address, bank routing number and account number. The letter must be on bank letterhead and signed by a bank representative. DO NOT SEND DEPOSIT SLIPS OR BANK STATEMENTS. Your name must appear on the account and the account must be with a United States financial institution.
**If the same payment has been deposited more than once into your account, child care will immediately correct the mistake and notify you of the removal of the duplicate funds from your account.
Your DHS Provider ID Number:__________________________________________
Your Phone Number:___________________________________________________