Submit Change to Provider Contact

Providers must report any temporary closures to Child Care Services as soon as possible. Temporary closures are considered unexpected interruptions in operation due to emergencies, health or safety concerns, or other unforeseen circumstances.
When submitting this request, please ensure the following information is provided:

*Provider Details
*Authorized Representative
* Type of Change (Add or Remove)
*Temporary Closure Reason
*Temporary Closure Dates

By submitting this form, you are informing Child Care Services of the Temporary Closure, when applicable, incorporated into the Provider Agreement Record for compliance and payment determination.

* All Requests are subject to review and verification.

Provider Details

Child Care Regulation Licensing No

Name of Facility

Authorized Representative

Name of Authorized Provider Representative

Authorized Rep Phone Number

Authorized Rep Email

Contact Change Type

Contact Change

Contact Person Details

First Name

Last Name

Role or Title

Contact Phone

Contact Email

Contact Person Mailing Address

Street Address

Address2

State

City

Zip Code

By submitting this form, you authorize the addition of new staff to conduct business with Child Care Services or the removal of staff who are no longer authorized.

Provider Certification

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After Submission

After submission, your inquiry is forwarded to our team and assigned to a dedicated Provider Coordinator who will begin processing it.

Processing

Our support team responds to all changes within 48 hours. For urgent issues, contact our hotline. Approved Pay Rates are updated in Kinder Systems.

Confirmation

Providers may receive confirmation once the Pay Rate has been updated, or be contacted if additional information is needed.

​Submit Change to Provider Contact