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DPHHS-QAD/CCL-025 Rev*7-2006 STATE OF MONTANA DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES QUALITY ASSURANCE DIVISION APPLICATION FOR REGISTRATION CERTIFICATE INFANT FAMILY OR GROUP DAY CARE HOME Provider Name Phone Facility Name E-Mail Facility Address Street City State Zip Mailing Address Street / PO Box Directions to day care from the nearest major street or highway Type of registration applying for Family family homes allow a maximum of 6 Children please check one box Group group homes...
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How to fill out dphhs-qadccl-025 - dphhs mt
How to fill out DPHHS-QAD/CCL-025
01
Obtain the DPHHS-QAD/CCL-025 form from the official website or relevant state agency.
02
Read the instructions carefully to understand the purpose of the form.
03
Fill in the applicant's name and contact information in the designated fields.
04
Provide details about the facility or service you are applying for, including its name and address.
05
Answer all required questions accurately, focusing on your compliance with regulations.
06
Attach any necessary supporting documents as specified in the instructions.
07
Review the completed form for any errors or omissions.
08
Sign and date the form where indicated.
09
Submit the completed form to the appropriate DPHHS office, either by mail or electronically.
Who needs DPHHS-QAD/CCL-025?
01
Individuals or organizations applying for licensure or certification in childcare services.
02
Providers seeking to comply with health and safety regulations in the state.
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What is DPHHS-QAD/CCL-025?
DPHHS-QAD/CCL-025 is a specific form used for reporting certain data related to child care licensing in the state of Montana. It is utilized by the Department of Public Health and Human Services (DPHHS) for data collection and assessment.
Who is required to file DPHHS-QAD/CCL-025?
Child care providers and facilities that are licensed by the DPHHS are required to file DPHHS-QAD/CCL-025 as part of the regulatory compliance process.
How to fill out DPHHS-QAD/CCL-025?
To fill out DPHHS-QAD/CCL-025, providers need to follow the instructions provided with the form, ensuring all required information is accurately completed, including facility details, licensing information, and relevant statistics.
What is the purpose of DPHHS-QAD/CCL-025?
The purpose of DPHHS-QAD/CCL-025 is to collect necessary data for monitoring and evaluating the quality of child care services in Montana, ensuring compliance with state regulations.
What information must be reported on DPHHS-QAD/CCL-025?
The form requires reporting information such as the number of children served, staff qualifications, health and safety protocols, and any incidents or violations that occurred during the reporting period.
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