CHILD CARE CENTER PROVISIONAL LICENSING PROCESS CHECKLIST by ftb12802

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									                 CHILD CARE CENTER
           PROVISIONAL LICENSING PROCESS
                     CHECKLIST

STEP 1
To start the licensing process, the following items need to be completed:

   Child Care Center Application-Signed by the Licensee
   Child Care Center Full Disclosure of Ownership Statement
    Licensee’s Felony / Misdemeanor Statement
   Complete Release of Information forms on all persons listed on the application
   Lawful Presence in the United States Attestation for Individuals / Co-owners
   $25.00 License Fee: 29 or fewer Children (Capacity)
   $50.00 License Fee: 30 or more Children (Capacity)
   Contact numbers to reach the Licensee and Director
   When the Dept receives the items listed above, the Step 2 packet will be sent to you

                     SEND THE ABOVE ITEMS TO:

                              DHHS – Division of Public Health
                              Licensure Unit -Children’s Services Licensing
                              NSOB – 3rd Floor
                              P.O. Box 94986
                              301 Centennial Mall South
                              Lincoln, NE 68509-4986

STEP 2
To continue the licensing process, the following items need to be completed:

   Sketch, diagram or print of the facility including room dimensions
   Sketch, diagram or print of the outdoor fenced play area including dimensions
   Sample Daily Schedule for each age group in care
   Sample weekly menu
   Director’s References
   Director’s Health Information Report


                                                                            LU-CCL-021 12/09
   Director’s Felony / Misdemeanor Statement
   Director’s Qualifications or Written Plan
   Director’s Completed Self-Assessment Forms ( required for all new directors)
   CURRENT DIRECTORS: If you currently hold the position of Director and / or have
    previously qualified as Director at another facility- please provide the facility name,
    locations, dates, and how you qualified ( see the regulation booklet)


STEP 3
Send items listed under STEP 2 (ALL TOGETHER) to the address listed above. Make
sure all items are completely filled out. If forms are not completed in full, the
packet will be returned.




                                                                           LU-CCL-021 12/09
    INSTRUCTIONS FOR APPLYING FOR A PROVISIONAL CHILD CARE
                        CENTER LICENSE

Thank you for your interest in starting a Child Care Center. Enclosed you will find forms
and instructions to guide you through the licensing process. Please take time to review
the instructions, forms, and Child Care Center Standards. Child Care is a very important
job.

Please keep in mind that this process does take time, and does involve other State and
Local Agencies. Please do not set an opening date for your facility, until the process is
completed, and your license has been issued. The process typically takes 60-90 days to
complete and your application will be processed in date order received.

     1. Child Care Center Application: Application needs to be current, accurate,
        and complete. Please list all staff including volunteers and substitutes.
        Application must be signed by Licensee.
     2. Child Care Center Full Disclosure of Ownership: Instructions are on the
        form.
     3. Felony/Misdemeanor Statement: Instructions are on the form. Licensee shall
        complete the forms and submit with other items listed. All other staff members,
        volunteers, and substitutes must complete the form prior to working at facility.
        Please ensure the forms are completed accurately, and signed/dated.
     4. Release of Information forms: Every person you list on the application must
        complete a release of information form. Copies must be included with your
        application in order for Children’s Services Licensing to conduct background
        checks. You will be notified if any of these persons fail to clear the background
        checks process. PLEASE NOTE: Any person between the ages of 13 to 19
        must have this form signed by their parent or guardian.
     5. Lawful Presence in the United States: If you are an individual owner and / or
        a co-owner with another individual you must complete the form. Please read the
        instructions on the form and submit with your application if appropriate.
        Applications from individuals cannot be processed without this form being
        completed and signed.
     6. License Fee: You will need to submit a check or money order (NO CASH)
        payable to Nebraska Department of Health and Human Services. $25.00
        License Fee for facilities with Capacity of 13-29 children. $50.00 License Fee
        for facilities with Capacity of 30 or more children. Your cancelled check will
        be your receipt. (NO REFUNDS) Please write your check number on your
        License Application.

                                                                          LU-CCL-021 12/09
     7.   Contact Numbers: You will need to send contact phone numbers for the
          Licensee and Director. Please send these on a separate sheet of paper.


When the above seven items are complete, send them to the following address

                              DHHS – Division of Public Health
                              Licensure Unit -Children’s Services Licensing
                              NSOB – 3rd Floor
                              301 Centennial Mall South
                              P.O. Box 94986
                              Lincoln, NE 68509-4986

If any of the forms are incomplete the packet will be returned to you.

Once the above completed items are received the Child Care Licensing Staff will make a
referral to the State of Nebraska, Fire Marshal’s Office, or Local Fire Authority and
Health Department. Also, at this time the Dept will send you the Step two packet.

 CITY OF LINCOLN APPLICANTS ONLY: If your Child Care Center will be in
  the City of Lincoln, you will need to contact the City Building and Safety Office at
  441-6435. If you have questions regarding Playgrounds, Health and Safety-
  Sanitation, such as Food Service/Kitchen, contact the Lincoln/Lancaster County
  Health Department at 441-8026.

 LOCAL DELEGATED FIRE AUTHORITIES: Several Nebraska communities
  have local delegated fire authorities who will conduct the fire inspections. These
  communities may have additional local ordinances, fire safety, parking, and zoning
  requirements. If you reside in the following communities, you can contact the
  delegated authority directly with questions specific to you community.

   City of Grand Island - Fire Inspector: Fred Hotz, 308-385-5444 Extension 228
   City of Norfolk- Fire Inspector: Scott Cordes, 402-844-2060
   City of North Platte - Fire Inspector: George Lewis, 308-535-6768.
   City of Scottsbluff - Fire Inspector: Shelia Hort, 308-630-6227

STEP 2
The items listed below must be submitted together to continue the licensing process
8. Sketch, Diagram, or Print of the Facility: Show the arrangement of rooms to be
   used by the children, including dimensions. The sketch, diagram, or print needs to be
   clear and legible.

9. Sketch, Diagram, or Print of the outdoor play area: including dimensions. The
   sketch, diagram, or print needs to be clear and legible.


                                                                         LU-CCL-021 12/09
10. Sample Daily Schedule: You will need to submit one schedule for each age group.
    (Infants, toddlers, preschool, and school-age.) These schedules should list time of
     day and activity offered at that time from opening to closing.

11. Sample Weekly Menu: You will need to submit one week’s sample menu. This
   would include breakfast/and or A.M. snack, Lunch, P.M. Snack, and Dinner if
   providing care beyond 7:00 P.M. All meals must meet USDA guidelines. Contact
   Department of Education-Food Program for more information.

Please note: The person listed on the application as “Director” must be at the
licensed site during the majority of the licensed hours. Your organization may use
different titles such as site supervisor or lead staff which, are sometimes confused
with titles used in licensing regulations. For licensing purposes, the person in charge
at each location must meet the director qualifications and be identified as the
Director on the application.

12 Director References: Please send a written record of 2 non-relative references.
   Please send copies, not originals.

13. Health Information Report: The Director completes Section A of the Health
   Information Report. A Medical Practitioner completes Section B. Health
   Information Reports shall be completed on a yearly basis
14. Felony/Misdemeanor Statement: Instructions are on the forms. Director shall
complete the form and submit with other items listed. All other staff members,
volunteers, and substitutes must complete the form prior to working at facility. Please
ensure the forms are completed accurately, and signed/dated.
15. Director Qualifications: See Child Care Standards booklet, page 6 Regulations
   #10 and #16. Please send copies, not originals of any documents.
    You must submit one of the following:
           1. CURRENT QUALIFIED DIRECTORS: If you currently hold the position
              of director and / or have previously qualified as director at another facility,
              please provide facility name, location, dates you were director, and how
              you qualified. Submit a copy of your DHHS-Director Certificate if
              applicable.
           2. NEW DIRECTORS: You must submit:
                 a. Centers licensed for 23 or more children: Documents supporting
                    the director meets the minimum education/ experience (ie: HS
                    diploma, degree, transcripts, verification of experience etc).
                    OR
                      b. Centers licensed for 22 or fewer children: Directors may qualify
                      through submission of a detailed and legible written plan for how
                      they will obtain qualifications within the next 12 months. This plan
                      must be approved by the Department

                                                                           LU-CCL-021 12/09
16. Director’s Self-Assessment Forms: This is part of step two. The person hired as
director must complete the Director Self Assessment. The assessment includes a DVD,
information and a Self-Assessment Forms. Please keep the information and video for
future reference. Self-Assessment Forms should be sent with the rest of the items in Step
two. You will be provided with a certificate of completion.

Next Step
Submit completed items 8-16 to:
                            DHHS – Division of Public Health
                             Licensure Unit -Children’s Services Licensing
                             NSOB – 3rd Floor
                             301 Centennial Mall South
                             P.O. Box 94986
                             Lincoln, NE 68509-4986

If any of the forms are incomplete the packet will be returned to you.

Please submit all items together. If any of the forms are incomplete, the packet will be
returned to you. Once all completed forms are received and our office has received Fire
Approval and Health Sanitation Approval, a Child Care Inspection Specialist will be
assigned to conduct an on-site inspection. Your Child Care Inspection Specialist will
contact you to set the appointment within 30 days.

If you have any questions regarding this process, please contact Cindy Strufing at 1-800-
600-1289 or 402-471-9562.




                                                                         LU-CCL-021 12/09

								
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