Enclosed you will find the forms necessary to apply
for a Child Care "Operating license".
A complete application packet must be submitted prior to the expiration
of your Provisional license.
Keep a copy of each completed form for your records
Please Read Carefully And Follow The Instructions In This Packet And
On Each Form!
Timely submittal of your paperwork is necessary to avoid a lapse in
your license. All forms, fee, and required documentation must be submitted
together for the application packet to be considered complete. If the
paperwork is incomplete in any way, the entire application packet will
be returned to the applicant for completion which will delay the licensing
process, and possibly affect payments you receive from the Food Program
and Child Care Subsidy (Title XX).
If you have moved since receiving your Provisional license, you must
have another Fire Safety Inspection. We will send a referral to the
appropriate Fire Marshal on your behalf. You will receive a bill directly
from the Fire Marshal for this inspection. You must pay this fee before
the Fire Marshal will send the results of the inspection to Children’s
- Application and Affidavit: Yourself, all family members and persons
living in the home, and substitutes/volunteers must be listed on this
form. Where applicable, provide maiden names, previous marriage names,
and/or other names for persons listed on the application form.
- Lawful Presence in the United States Attestation: As of October 1,
2009, any individual applying for initial licensure or renewing a Family
child Care Home I license must attest to their lawful presence in the
United States in order to comply with Nebraska Revised Statutes, §§4-108
- Felony/Misdemeanor Statement/s: Each person listed on the application
who is 19 years or older must complete and sign a Felony/Misdemeanor
Statement. Full disclosure of all law enforcement contact is required
regardless of the age at contact and will be verified in the licensing
process. On the Statement form, include the date and location of each
law enforcement incident, the charges, and disposition (for example,
parole, probation, incarceration, fine, community service, etc).
- Adding New Substitute/Volunteer: A new substitute/volunteer is required
to complete an Authorization for Release of Information form in addition
to completing a Felony/Misdemeanor Statement.
- Rules Compliance Checklist: Respond on this form to indicate your
compliance with Child Care Regulations. Use the Checklist as a tool
to correct any areas that are not currently in compliance.
- Documentation of completion of the required 12 hours of annual In-Service
training must accompany your completed application paperwork. Only one
instance of CPR and First Aid training will be accepted for the 12 month
period of the Provisional license.
- Include a check or money order payable to State of Nebraska for the
$25 licensing fee. DO NOT SEND CASH! NOTE: THE LICENSING FEE IS NON-REFUNDABLE.