Apply for Child Care Payment Assistance

1. Long form birth certificate, OR
2. Record of Live Birth for children under the age of three (3) months until long form birth certificate is received.

Eligibility is based on gross family income. Applicants must provide proof of income for the last thirty (30) days to include one (1) of the following:

1. Check stubs
   • One (1) if paid monthly- must include the most recent check stub issued; or
   • Two (2) if paid bi-monthly- must include the last two consecutively issued check stubs; or
   • Four (4) if paid weekly-must include the last four consecutively issued check stubs.
2. Estimated quarterly tax report
3. Federal 1040 tax form—line 9 (total income)
4. Schedule C Form 1040—line 7 (gross income)
5. New Employment/ Employment at Temporary Agency-If employed for less than 30 days, you must submit a letter from your employer on company letterhead with the following information: start date of employment, pay rate, work schedule including hours worked, method of pay, employer name, employer address, employer phone number, or a completed wage verification form.
6. Paid in Cash—Wage-Verfication-Form_2023, or a notarized letter from the employer verifying employment, income, rate of pay, and number of hours worked. The letter must also include the employer’s name, address, telephone number, and state that the employee is paid in cash
7. Paid by Personal Check—applicants must submit copies of the front and back of two checks that have cleared the bank.
8. Self-Employed with Filed Tax Return:
   • completed Wage Verification Form, and
   • copy of an Estimated Quarterly Tax Report or
   • Federal 1040 Tax Form with the Profit/Loss Statement (Schedule C):
     The Total Sales and Receipts amount located on the Profit/Loss Statement will be used to determine if the work requirement has been met. The amount located on Line 22 of the Federal 1040 Tax Form to determine income eligibility
9. Self-Employed, New Business- for businesses started within the current tax year
   • completed Wage Verification Form, and
   • current business license

This information is required for the applicant, spouse, and any biological parent living in the home.

Parents must provide proof of work for the last thirty (30) days to include one (1) of the following:

1. Check stubs
   • One (1) if paid monthly- must include the most recent check stub issued; or
   • Two (2) if paid bi-monthly- must include the last two consecutively issued check stubs; or
   • Four (4) if paid weekly-must include the last four consecutively issued check stubs.
2. New Employment or Employment at Temporary Agency—letter from the employer on company letterhead verifying employment, income, rate of pay, and number of hours worked.
3. Paid in Cash—a wage verification form, or a notarized letter from the employer verifying employment, income, rate of pay, and number of hours worked. The letter must also include the employer’s name, address, and telephone number, and state that the employee is paid in cash.
4. Self-Employed—a wage verification form and a copy of the business license.
5. Paid by Personal Check—applicants must submit copies of the front and back of two checks that have cleared the bank.
6. Medical Leave—if the parent is on medical leave at the time of application or redetermination, a letter on employer letterhead may be submitted to satisfy this requirement. This letter must include rate of pay, hours typically worked per pay period, frequency of pay, and an expected date of return to work.

This information is required for the applicant, spouse, and any biological parent living in the home.

If the parent is not working at least twenty-five (25) hours per week, he/she must be enrolled in an approved full-time educational or training program resulting in a degree or certificate designed to promote job skills and employability, including but not limited to GED classes. Educational programs must be accredited by the State of Mississippi or a national organization. Full-time enrollment is defined by the institution providing the education and/or job training program.

Acceptable proof includes:

1. Letter from the institution’s Registrar confirming current full-time enrollment, or
2. Printout of the current class schedule verifying full-time status with applicant’s name on schedule. If redetermination is occurring between semesters/quarters, a copy of the applicant’s future course schedule may be submitted, provided that the next semester/quarter begins within 30 days of the submission.

Teen Parents in High School

1. You must submit verification from school Principal indicating full-time enrollment.
2. If you are living at home with your parent(s) and they are under the age of 65, your parents must be working the required 25 hours per week and check stubs must be submitted.

NOTE: If you are living at home with your parent(s), your parents cannot be paid for providing care for your child.

If the parent shows proof of less than twenty- five (25) work hours per week, or less than full-time enrollment in an educational or job training program, educational hours from an approved educational or training program may be combined with work hours, to meet the requirement.

1. Educational hours—may be a combination of actual classroom hours and designated study hours; cannot be carried over from week to week
2. Actual classroom hours—the time actually spent in the classroom setting
3. Designated study hours—allowed in a 1:1 ratio with actual classroom hours, and cannot exceed actual classroom hours

A. Documents must contain both parent/applicant and child’s name. Acceptable proof includes:

1. Long form birth certificates, or
2. Court documents indicating custody, or
3. Elementary/Middle/High School registration documents produced by the school.

B. If the child’s parent is unable to act as the parent or if the parent has delegated his or her authority to someone else, acceptable forms of guardianship verification include:

1. MDHS Guardianship/In Loco Parentis Verification form (if the signing parent’s identity and relationship can be verified)
2. Court Order

A. The address on the documents must verify a Mississippi address, and at least one (1) must verify the address listed on the application. The address listed on the application should accurately reflect where the applicant resides, even if on a temporary basis. Acceptable forms include:

1. Valid Mississippi driver’s license
2. Valid state issued ID
3. Current bank statement
4. Current cell phone bill
5. Current utility bill
6. Current cable bill
7. Current employment records
8. Rent/lease agreement effective as of the date the document is submitted to MDHS

B. Current documents must be dated, with a date no more than thirty (30) days prior to application submission date. If the applicant resides at a temporary address and cannot produce a corroborating document, the applicant and applicant’s host must complete and submit a MDHS Transitional Living form.

C. If a parent attends school in/out of state, the application shall be made in the parent’s name using the address where the child(ren) reside(s). Parents and children must reside in the State of Mississippi to participate in the CCPP. CCDF has subsidy programs in all 50 states, and out of state residents are encouraged to apply for subsidy in the state of residence.

Acceptable forms include:

1. One (1) Photo ID for the applicant:
   • Driver’s license, or
   • Other state issued photo ID, or
   • Passport or other government issued photo ID
2. If no Photo ID available, must submit two (2) forms of identity verification for the applicant.
   • Work or school ID
   • ID for health benefits
   • Voter registration card
   • Birth certificate
   • EBT card
   • EPPICard

1. Supplemental Security Income (SSI) award letter, or 
2. Social Security Administration (SSA) award letter.
   • Award letters must be dated, with a date no more than twelve (12) months prior to application submission date. 
   • If a parent meets the special needs requirement, the work requirement is waived for that parent only.