Nebraska Nebraska
State Requirements

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In making this application, you state that:
1. I have read and understand the Family Child Care Home I Standards as issued by the Nebraska Department of Health and Human
Services System under Nebraska law for the operation of a Family Child Care Home I (Nebraska Revised Statutes, Sections 71-1908
through 71-1917).
2. I give the Department of Health and Human Services System permission to check my name and all household members and substitutes
age 13 and older against the Nebraska Child Abuse and Neglect Central Registry.
3. I give the Department of Health and Human Services System permission to check my name and all household members and substitutes
age 18 and older against the Nebraska Adult Protective Services Central Registry.
4. I comply and will continue to comply with the rules for operating a Family Child Care Home I and the terms of my license.
5. I have provided and will continue to provide each parent of the children served in my home with a copy of the Department of Health
and Human Services Systems' Parent Handbook.
6. I give the Department of Health and Human Services System staff permission to make the necessary inspections of my home to
determine my compliance with the regulations.
7. I understand that the Department of Health and Human Services System staff may take photographs of the child care designated areas
of my home.
8. I give the Department of Health and Human Services System and the State Fire Marshal's office permission to make the necessary
inspections of my home to determine my compliance with the regulations.
9. I understand that any complaints about my Family Child Care Home will be investigated by a representative of the Department of Health
and Human Services System and the identity of the complainant shall remain confidential.
10. I understand that designated Department of Health and Human Services System staff may release specific requested information
concerning my licensing file to the public upon written or verbal request.
11. I am aware that to operate a Family Child Care Home in Nebraska without a license is in violation of Nebraska Revised Statutes, Sections
71-1908 through 71-1917.

NEBRASKA FAMILY HOME 1 DAYCARE LICENSING APPLICATION


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