[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-304027-105":53,"doc-detail-304027-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","child-care-subsidy-application-form-department-opm-1643","Child Care Subsidy Application Form - Department OPM 1643","","Child Care Subsidy Application Form OPM 1643 collects parent or legal guardian and child information required for processing a federal childcare subsidy request. It specifies supporting attachments, including recent pay statements, federal and state tax returns, and the provider’s latest license or compliance statement. The form captures contact details, work and home addresses, employment and spouse information, and total family income. It also lists each child’s enrollment and provider details, weekly childcare costs, application type, other subsidy sources, and signature certifications, with guidance on incomplete submissions and privacy act obligations.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/child-care-subsidy-application-form-department-opm-1643/304027/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/child-care-subsidy-application-form-department-opm-1643/304027.png","ImageObject",442,249,{"name":88,"@type":89},"Aurelia","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-24","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":76},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What supporting documents must be attached to the Child Care Subsidy Application?","Question",{"text":108,"@type":109},"Attach pay statements for the most recent two pay periods for each parent or guardian, a copy of the most recent federal and state income tax returns, and a copy of the child care provider’s most recent license or statement of compliance. Also include a completed OPM Form 1644 signed by the provider(s).","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What information is required in Section I for the parent or legal guardian?",{"text":113,"@type":109},"Section I collects the applicant’s name, SSN, grade, work and home addresses, email and telephone numbers, category (single/couple), spouse federal employee status, spouse details, and total family income as reported on the most recent IRS Form 1040/1040A (with a copy).",{"name":115,"@type":106,"acceptedAnswer":116},"What must be completed in Section II for each child?",{"text":117,"@type":109},"List each child’s name, child SSN, date of birth, child care provider name and address, weekly childcare cost, date of enrollment, type of application, whether other state/county/local subsidies are received (and source/amount if yes), and the type of care (center-based or family home-based).","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},304027,1790120978,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":76,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},1099514068365,"https://ap-avatar.wpscdn.com/avatar/10000253d8d9f28188e?_k=1776742907772140068","CHILD CARE SUBSIDY APPLICATION FORM DEPARTMENT    \n(Insert Federal Agency Name)  \nThe department   may contact the applicant to request clarification on the subsidy application.  \n(Insert name of organization administering the program)  \nYou must attach the following documents:  \n1. Pay statements for the most recent two pay periods for each parent or guardian;  \n2. A copy of your most recent Federal and State income tax returns;  \n3. A copy of your child care provider's most recent license or statement of compliance with State and/or local childcare regulations; and  \n4. A completed OPM form 1644, signed by the provider(s) below.  \n\n| Section I -Parent / Legal Guardian Information |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Applications that are not fully completed or do not contain the information listed below will not be processed and will be returned to the applicant. If you do not provide all of the information requested, you will not receive a subsidy award. When more than one parent works for the Federal Government, subsidies cannot be awarded for the child/children by more than one Federal agency. |  |  |  |  |  |  |  |\n| 1. Name (Last, first, middle initial) |  |  |  | 2. Social Security Number (SSN) |  |  | 3. Grade |\n| 4. Work address (Include street number, city, state and ZIP code) |  |  |  |  | 5. Work e-mail address |  |  |\n|  |  |  |  |  | 6. Work telephone number |  |  |\n| 7. Home address (Include street number, city, state and ZIP code) |  |  |  |  | 8. Home e-mail address |  |  |\n|  |  |  |  |  | 9. Home telephone number |  |  |\n| 10. Category of\u003Cbr>parent Single Couple | 11. Spouse federal\u003Cbr>employee Yes No | 12. Name of spouse (Last, first, middle initial) |  |  |  |  |  |\n|  |  | 13. Employing agency of spouse |  |  |  |  | 14. Grade of spouse |\n| 15. Total family income as reported on adjusted gross income line of most recent IRS form 1040/1040A\u003Cbr>*Include a copy of the IRS form |  |  |  |  |  |  |  |\n| Section II -Child Information |  |  |  |  |  |  |  |\n| List information for all children for whom you are applying for a subsidy. (If you are applying for more than three children please attach the pertinent information to this form) |  |  |  |  |  |  |  |\n| 1a. Name of first child |  |  |  | b. SSN of child |  | c. Date of birth (MM/DD/YYYY) |  |\n| d. Name of child care provider |  |  |  | e. Weekly child care cost |  | f. Date of enrollment (MM/DD/YYYY) |  |\n| g. Type of application (Check one)\u003Cbr>New family Adding/changing family information Reapplication (previously enrolled, not current)\u003Cbr>Annual recertification Changing provider information (attach new license and OPM Form 1644) |  |  |  |  |  |  |  |\n| h. Is any other form of State, County or Local subsidy being received for the child(ren)?\u003Cbr>Yes (If \"Yes\", complete i. and j.) No |  |  | i. Source of subsidy |  |  |  |  |\n|  |  |  | j. Amount of subsidy |  |  |  |  |\n| k. Address of provider (Include street number, city, state and ZIP code) |  |  |  |  | l. Telephone number of child care provider |  |  |\n|  |  |  |  |  | m. Type of care\u003Cbr>(Check one) | Center-based care\u003Cbr>Family home-based care |  |\n\nOffice of Personnel Management Form authorized for local reproduction OPM 1643  \nRevised May 2003  \n\n| Section II -Child Information (Continued) |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| 2a. Name of second child |  | b. SSN of child |  | c. Date of birth (MM/DD/YYYY) |\n| d. Name of child care provider |  | e. Weekly child care cost |  | f. Date of enrollment (MM/DD/YYYY) |\n| g. Type of application (Check one)\u003Cbr>New family Adding/changing family information Reapplication (previously enrolled, not current)\u003Cbr>Annual recertification Changing provider information (attach new license and OPM Form 1644) |  |  |  |  |\n| h. Is any other form of State, County or Local subsidy being received for the child(ren)?\u003Cbr>Yes (If \"Yes\", complete i. and j.) No | i. Source of subsidy |  |  |  |\n|  | j. Amount of subsidy |  |  | ","cbCaiirE4EKzOeIw","https://ap.wps.com/l/cbCaiirE4EKzOeIw","pdf",284710,"English","# Section I - Parent / Legal Guardian Information\n## Required Information and Eligibility Notes\n# Section II - Child Information\n## Enrollment, Provider, and Subsidy Details for Each Child\n# Section III - Signature of Parent / Legal Guardian\n## Certification and False Statement Warning","[{\"question\":\"What supporting documents must be attached to the Child Care Subsidy Application?\",\"answer\":\"Attach pay statements for the most recent two pay periods for each parent or guardian, a copy of the most recent federal and state income tax returns, and a copy of the child care provider’s most recent license or statement of compliance. Also include a completed OPM Form 1644 signed by the provider(s).\"},{\"question\":\"What information is required in Section I for the parent or legal guardian?\",\"answer\":\"Section I collects the applicant’s name, SSN, grade, work and home addresses, email and telephone numbers, category (single/couple), spouse federal employee status, spouse details, and total family income as reported on the most recent IRS Form 1040/1040A (with a copy).\"},{\"question\":\"What must be completed in Section II for each child?\",\"answer\":\"List each child’s name, child SSN, date of birth, child care provider name and address, weekly childcare cost, date of enrollment, type of application, whether other state/county/local subsidies are received (and source/amount if yes), and the type of care (center-based or family home-based).\"}]","Child Care Subsidy Application Form - Department OPM 1643 | PDF",1789809119]