State Requirements

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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 Services Licensing.

- 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 through 4-114.
- 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.

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